AI denial management, prevention first.
Denial autonomy
Claim #8842 · Commercial PPO
Denial risk
Low
Appeal letter auto-drafted with cited evidence, ready for human review.
typical
11 daysremittance signal to drift alert
up to
80%overturn on the cases we pursue
up to
10xfaster appeal review cycles
It flags the fixable defect before the claim files.
Risk Prediction scores every claim while it is still editable. The point is not a risk number; it is the specific defect you can still fix.
Scored pre-bill
Denial risk is scored before submission, against learned payer behavior for that payer, plan, and claim shape, not discovered on the remittance.
The defect, named
Missing modifier, absent prior authorization, medical-necessity gap: the flag names the fixable defect, so the fix is specific.
Intervene while it's editable
Teams correct claims pre-bill instead of appealing them post-denial. That is the cheapest denial you will ever work.
Risk Prediction
Scored pre-bill · claim still editable
Denial risk
4%
was 31% at intake
Learned payer behavior · payer × plan × claim shape
Defensible coding, with the evidence attached.
Documentation and coding gaps surface upstream, each with its clinical evidence, so denials driven by the chart stop at the chart.
Verified against the note
ICD-10, CPT, HCPCS, and HCC assignment checked against the documentation itself, not around it.
Evidence on every suggestion
Each recommendation links to the note, flowsheet, or report that supports it, so coders defend decisions instead of reconstructing them.
Human-in-the-loop
Reviewers approve consequential changes, and audit-ready trails record every step.
CDI & Coding Integrity
Verified against the documentation
See the payer change before the bulletin lands.
Neurex reads your own remittance data for behavior shifts. A rules engine finds out when the payer publishes; you find out when the pattern starts.
Payer drift detection
Detected from your own remittance data, with a documented detection-to-alert window of about 11 days from the first inbound signal.
Outcome tracker
30, 60, and 90-day rolling baselines per payer and claim shape. A statistically significant deviation triggers an alert carrying dollars at risk and a suggested action.
Policy intelligence
NCD, LCD, and payer bulletins summarized with a severity score, tied to the impacted claims, codes, and service lines.
Plan-level tracking
Behavior tracked per Medicare Advantage plan and claim category, because an average can hide a concentrated problem.
Payer Insights & Pattern Detection
Watching your own remittance data
Day 0
First inbound remittance signal
~Day 11
Neurex drift alert: dollars at risk + suggested action
typically ~6 days later
Payer publishes the bulletin
Documented deployment observations, not an SLA. In one documented pattern, the alert fired 17 days before the bulletin.
A 12% average can hide a 22% problem on one plan’s cardiac claims.
Appeals that are cited, approved, and getting smarter.
When a denial does land, the packet that answers it is payer-specific, evidence-backed, and reviewer-approved. And it teaches the engine something.
Cited and evidence-backed
NCD and LCD citations, InterQual and MCG references, documentation excerpts, and deadline tracking in every packet.
Approval before filing
An approval workflow gates every appeal. Nothing files without reviewer sign-off.
The Appeal Intelligence Flywheel
Patent-pending. Every outcome and reviewer edit feeds back, so the argument patterns that win propagate to the next appeal.
Ask Neurex Copilot
Reviewers validate complex appeals in minutes with healthcare-native search across clinical evidence, payer rules, prior outcomes, and case context: up to 10x faster review cycles.
Appeal Generation
Appeal packet · CO-97 · medical necessity
Per NCD 220.6, the service meets medical-necessity criteria for this presentation[1]. Documentation supports the level of care under InterQual[2] and MCG[3]; the operative note excerpt is attached[4].
awaiting reviewer sign-off · nothing files without approval
Every outcome and reviewer edit feeds the Appeal Intelligence Flywheel (patent-pending), so the argument patterns that win propagate to the next appeal.
Where it converges
All four stations converge at Revenue Recovery Central.
Recovered dollars, prevented denials, and open work in one operational view, built for the people who answer to the board.
Explore Revenue Recovery Centralup to
80%appeal overturn rate on the cases we pursue
HIPAA-aligned · SOC 2 Type II readiness · Security at Neurex
AI denial management, answered
Straight answers to the questions revenue cycle teams ask first.
The use of machine intelligence to prevent, work, and appeal claim denials instead of staffing to the backlog. Neurex runs it as four stations: Risk Prediction and CDI & Coding Integrity prevent the denial before submission, while Payer Insights & Pattern Detection and Appeal Generation handle what payers do next. A human stays in the loop on every consequential action.
Many can. Every claim is scored against learned payer behavior for that payer, plan, and claim shape, and the fixable defect, such as a missing modifier, an absent prior authorization, or a medical-necessity gap, is flagged while the claim is still editable. Teams intervene pre-bill instead of appealing post-denial.
A gradual, unannounced change in how a payer adjudicates a claim type, visible in remittance patterns before any policy bulletin. Neurex detects it from the client's own remittance data, with a documented detection-to-alert window of about 11 days from the first inbound signal, typically about 6 days before the payer publishes the bulletin.
Appeal packets are payer-specific and evidence-backed: policy citations from NCDs and LCDs, clinical criteria references from InterQual and MCG, documentation excerpts, and deadline tracking, with an approval workflow before anything files. The documented overturn rate is up to 80% on the cases Neurex pursues.
No. Nothing consequential files without reviewer sign-off. Reviewers validate complex appeals with Ask Neurex Copilot, a healthcare-native search and response engine that unifies clinical evidence, payer rules, prior outcomes, and case context, at up to 10x faster review cycles. Every decision carries an audit-ready trail.
See it on your own denials.
A pilot with success criteria you set, and an outcome-based engagement: Neurex is paid on the revenue it recovers.
Human-in-the-loop on consequential actions · Audit-ready trails