Using Data, Not Drama, to Win Medical Appeals
Using Data, Not Drama, to Win Medical Appeals
Using Data, Not Drama, to Win Medical Appeals
Meet the AI agent turning NOs into YESes
Meet the AI agent turning NOs into YESes
Every denied claim is a revenue opportunity - if you can act fast enough. Our Medical Appeal Agent helps healthcare providers recover revenue that would otherwise be lost in the backlog.
Every denied claim is a revenue opportunity - if you can act fast enough. Our Medical Appeal Agent helps healthcare providers recover revenue that would otherwise be lost in the backlog.
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The $260 Billion Problem
The $260 Billion Problem
Every year, 1 in 5 medical claims is denied on first submission.
Every year, 1 in 5 medical claims is denied on first submission.
Manual appeals take 15 to 45 days to process, creating dangerous delays that affect both patients and providers.
Denied claims lead to postponed treatments, overwhelmed systems, and mounting frustration — for care teams, finance teams, and patients alike.
Hospitals, clinics, and RCM teams are drowning in unresolved denials and mounting backlogs.
Denied claims lead to postponed treatments, overwhelmed systems, and mounting frustration — for care teams, finance teams, and patients alike.
Hospitals, clinics, and RCM teams are drowning in unresolved denials and mounting backlogs.
Administrative staff are pushed to their limits, navigating outdated systems and complex payer rules.
Operational bottlenecks disrupt cash flow and slow down decision-making.
Patient trust deteriorates when care is stalled due to financial red tape.
Administrative staff are pushed to their limits, navigating outdated systems and complex payer rules.
Operational bottlenecks disrupt cash flow and slow down decision-making.
Patient trust deteriorates when care is stalled due to financial red tape.
Manual appeals take 15 to 45 days to process, creating dangerous delays that affect both patients and providers.
It’s time to stop accepting “no” as the final answer
It’s time to stop accepting “no” as the final answer
Let automation handle the repetition. Let your teams focus on care.
Let automation handle the repetition. Let your teams focus on care.
Meet the Medical Appeal Agent
Meet the Medical Appeal Agent
Faster, Smarter, Revenue Recovery.
Faster, Smarter, Revenue Recovery.
Built specifically for healthcare providers, the Medical Appeal Agent transforms how you handle denied claims. It replicates the judgment of expert billers - at scale and at speed.
Built specifically for healthcare providers, the Medical Appeal Agent transforms how you handle denied claims. It replicates the judgment of expert billers - at scale and at speed.
Trained on a vast dataset of 100,000+ historical approvals, the agent knows what works and why. It analyzes each denial, identifies the right legal or medical precedent, and drafts insurer-specific, fully compliant appeal letters - automatically.
Trained on a vast dataset of 100,000+ historical approvals, the agent knows what works and why. It analyzes each denial, identifies the right legal or medical precedent, and drafts insurer-specific, fully compliant appeal letters - automatically.
What once took 30–45 minutes, now takes less than 90 seconds. That’s not just speed - that’s scale, savings, and smarter strategy.
What once took 30–45 minutes, now takes less than 90 seconds. That’s not just speed - that’s scale, savings, and smarter strategy.
How It Works
How It Works
Step 1: Understands the Denied Claim
Step 1: Understands the Denied Claim
Instantly ingests denial reason, clinical codes, and documentation
Identifies missing information, code mismatches, or misalignments
Learns payer-specific language and rules for appeal logic
It doesn't just read - it understands.
It doesn't just read - it understands.
Step 2: Learns from 100,000+ Successful Appeals
Step 2: Learns from 100,000+ Successful Appeals
Cross-references real-world approvals across insurers, procedures, and patient types
Finds similar historical cases and pulls out what worked
Surfaces proven, data-backed medical arguments
It appeals with evidence, not assumptions.
It appeals with evidence, not assumptions.
Step 3: Builds the Perfect Appeal Letter
Step 3: Builds the Perfect Appeal Letter
Aligns denial with policy language, coding standards, and clinical guidelines
Finds matching precedents and builds medical necessity justification
Crafts an insurer-specific, fully compliant appeal document
What you get is not just a letter - it's a winning case.
What you get is not just a letter - it's a winning case.
Step 4: Delivered in Under 90 Seconds
Step 4: Delivered in Under 90 Seconds
Automatically generates appeals in real time
Seamlessly integrates with your claim management workflow
Zero added headcount. Infinite scalability.
Automatically generates appeals in real time
Seamlessly integrates with your claim management workflow
Zero added headcount. Infinite scalability.
What took days now takes seconds.
What took days now takes seconds.
Step 1: Understands the Denied Claim
Instantly ingests denial reason, clinical codes, and documentation
Identifies missing information, code mismatches, or misalignments
Learns payer-specific language and rules for appeal logic
It doesn't just read - it understands.
Step 2: Learns from 100,000+ Successful Appeals
Cross-references real-world approvals across insurers, procedures, and patient types
Finds similar historical cases and pulls out what worked
Surfaces proven, data-backed medical arguments
It appeals with evidence, not assumptions.
Step 3: Builds the Perfect Appeal Letter
Aligns denial with policy language, coding standards, and clinical guidelines
Finds matching precedents and builds medical necessity justification
Crafts an insurer-specific, fully compliant appeal document
What you get is not just a letter - it's a winning case.
Step 4: Delivered in Under 90 Seconds
Automatically generates appeals in real time
Seamlessly integrates with your claim management workflow
Zero added headcount. Infinite scalability.
What took days now takes seconds.
See the Before & After
See the Before & After
Metric
Metric
Time per appeal
Time per appeal
Appeals processed/day/staff
Appeals processed/day/staff
Cost per appeal
Cost per appeal
Revenue recovered/month
Revenue recovered/month
Appeal success rate
Appeal success rate
Resubmission time
Resubmission time
Compliance consistency
Compliance consistency
Staffing needs
Staffing needs
Before (Manual)
Before (Manual)
30–45 minutes
30–45 minutes
~12–15 appeals
~12–15 appeals
~$25–$35 (labor + overhead)
~$25–$35 (labor + overhead)
~$50K–$100K (limited staff)
~$50K–$100K (limited staff)
~30–45% (depends on experience)
~30–45% (depends on experience)
~30–45% (depends on experience)
~30–45% (depends on experience)
Days to weeks (manual cycles)
Days to weeks (manual cycles)
Varies by staff knowledge
Varies by staff knowledge
Varies by staff knowledge
Varies by staff knowledge
Growing team to scale appeal ops
Growing team to scale appeal ops
After (With AI Agent)
After (With AI Agent)
60–90 seconds
60–90 seconds
400+ appeals (no human bottleneck)
400+ appeals (no human bottleneck)
<$1 (zero marginal cost per letter)
<$1 (zero marginal cost per letter)
~$500K+ with AI-driven scale
~$500K+ with AI-driven scale
70–85% (based on precedent-matching AI)
70–85% (based on precedent-matching AI)
Immediate (letters ready in real-time)
Immediate (letters ready in real-time)
100% consistent, payer-specific guidelines embedded
100% consistent, payer-specific guidelines embedded
Zero hiring required for appeal scaling
Zero hiring required for appeal scaling
The Numbers Speak for Themselves.
The Numbers Speak for Themselves.
Every year, 1 in 5 medical claims is denied on first submission.
Every year, 1 in 5 medical claims is denied on first submission.
5× more appealssubmitted
5× more appealssubmitted
without hiring more staff
without hiring more staff
70–90% approval rate
70–90% approval rate
for AI-generated appeal letters
for AI-generated appeal letters
90% reduction
90% reduction
in time spent drafting per appeal
in time spent drafting per appeal
Claims backlogs resolved within 30 days
Claims backlogs resolved within 30 days
of deployment
of deployment
5× more appealssubmitted
without hiring more staff
70–90% approval rate
for AI-generated appeal letters
90% reduction
in time spent drafting per appeal
Claims backlogs resolved within 30 days
of deployment
Why It Matters
Why It Matters
For too long, healthcare providers have had to accept revenue leakage as a cost of doing business. Not anymore. The Medical Appeal Agent is designed to help your organization:
For too long, healthcare providers have had to accept revenue leakage as a cost of doing business. Not anymore. The Medical Appeal Agent is designed to help your organization:
Recover revenue that was previously written off
Recover revenue that was previously written off
Empower your billing team to focus on high-value work
Empower your billing team to focus on high-value work
Respond to denials faster than ever before
Respond to denials faster than ever before
Ensure compliance with payer-specific requirements.
Ensure compliance with payer-specific requirements.
Achieve ROI in days - not months
Achieve ROI in days - not months
Your Denied Claims Are WaitingLet’s Win Them Back
Your Denied Claims Are WaitingLet’s Win Them Back
Don’t let your next denied claim go unchallenged. In under 2 minutes, the Medical Appeal Agent can turn it into recovered revenue.
Don’t let your next denied claim go unchallenged. In under 2 minutes, the Medical Appeal Agent can turn it into recovered revenue.
Schedule a Demo with Our Team
© 2025 Copyright One Realm, Inc
© 2025 Copyright One Realm, Inc