Denied claims are earned revenue. Stop writing them off.
65% of denied healthcare claims are never appealed because manual rework costs $57 per claim. RecoupOps ingests your 835 remittances, predicts overturn probability, and drafts clinical appeals in seconds.
Most denials aren't unwinnable. They're just unworked.
When it costs $57.23 in staff labor to manually research and rework the average denied claim — up from $43.84 the year prior (Premier Inc.) — a $120 denial isn't worth a biller's afternoon. So it gets written off. Multiply that decision across a year and you have the single largest voluntary revenue loss in the practice.
Industry-wide benchmark published by HFMA. Due to biller labor limits, billions in earned revenue are abandoned annually.
Appeals work. When practices take the time to submit clinical justifications, the vast majority of denied dollars are recovered.
Premier Inc. records a 30.5% surge in rework expense. HFMA/MGMA estimate ranges up to $118 per complex surgical claim.
Change Healthcare National Claims Study
Premier Inc. Administrative Expense Report
Experian Health State of Claims 2025
Four steps from remittance ingest to cash recovery.
No rip-and-replace. Connect your clearinghouse or PM, let RecoupOps draft the packets, and watch your write-off rate plummet.
Connect Remittances
RecoupOps ingests 835/ERA files directly from your clearinghouse, PM system, or SFTP drop. Read-only to start, zero workflow disruption.
Classify Every Denial
CARC/RARC parsing, root-cause grouping, payer behavior patterning, and appeal-worthiness expected value scoring.
Draft Clinical Appeals
Payer-specific appeal letters with exact LCD/NCD citations, medical necessity language, and attached operative notes.
Track Timely Filing
Deadline engine monitors filing windows by payer and state. Proactive alerts ensure no recoverable claim expires.
The odds on appeal are better than almost anyone realizes.
Under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), insurers were required to publish calendar year 2025 prior-authorization data by March 2026. KFF analyzed it in August 2026. The results prove that denials are an administrative obstacle, not an absolute barrier.
Major Payer Prior-Authorization Denial & Overturn Rates
| Payer Organization | PA Denial Rate | Expedited Denial Rate | Overturned on Appeal | Median Response | Operational Intelligence | Guide |
|---|---|---|---|---|---|---|
| Centene | 15% | 13% | 93% | 1.0 days | Overwhelming majority of denials overturned upon timely submission of chart notes. | Playbook |
| CVS Health (Aetna) | 8% | 11% | 89% | 1.1 days | High overturn rate when CPB (Clinical Policy Bulletins) are explicitly referenced. | Playbook |
| Elevance Health | 5% | 3% | 75% | 1.4 days | Lowest baseline PA denial rate, but responsive to peer-to-peer documentation attachments. | Playbook |
| Humana | 7% | 10% | 64% | 0.9 days | Strict Medicare Advantage guideline enforcement; fast response to online portal filings. | Playbook |
| UnitedHealth Group | 17% | 11% | 60% | 1.2 days | Highest PA denial rate among top 6 commercial carriers; high overturn on level 1 clinical re-review. | Playbook |
| Kaiser Permanente | 13% | 7% | 40% | 0.8 days | Closed HMO network rules require precise out-of-network continuity citation. | Playbook |
Engineered specifically for revenue cycle teams.
Denial Classification & Triage
Parses 835 remittances, groups CARC/RARCs into upstream root causes, and assigns expected value appeal scores.
AI Clinical Appeal Generation
Drafts multi-page dispute letters with verified LCD citations, statutory parity clauses, and indexed medical attachments.
Deadline & Timely Filing Engine
Per-payer appeal windows and state-specific regulatory deadlines with automated escalations before claims expire.
Contract Underpayment Audits
Models contracted fee schedules and flags silent line-item underpayments disguised as standard CO-45 contractual adjustments.
Payer Scorecards & Analytics
Overturn telemetry, days to pay, and root-cause routing back to front-desk registration and coding teams.
Clearinghouse & EHR Connectors
Pre-built integrations for athenahealth, Epic, Availity, Waystar, Kareo, eCW, and custom SFTP batch pipelines.
Built for your operating model.
Whether you manage revenue for 50 provider clients or run a 20-physician surgical group.
Work more denials without adding billing headcount.
Billing companies are paid a percentage of collections but pay billers by the hour. At $57 per claim rework cost, low-dollar denials are loss-making units of work. RecoupOps removes the labor friction, unlocking pure margin and client retention.
- Multi-tenant client workspace segregation
- White-label client recovery reporting
- Per-claim or revenue-share partner pricing
Too big to ignore denials. Too small for enterprise RCM.
Mid-sized specialty practices lose between $400k and $2M annually in avoidable write-offs while billers burn out managing fax queues. RecoupOps provides enterprise-grade denial automation with zero IT complexity.
- Cut avoidable write-offs by 60–75% in 90 days
- Live in < 48 hours without changing billing systems
- Transparent per-provider flat monthly rate
Estimate Your Recoverable Revenue
Grounded strictly in HFMA, Premier Inc., and KFF published overturn statistics.
Cash returned on claims your team currently writes off as unprofitable to work.
Proven recovery across specialties.
Read how billing companies, orthopedic groups, and behavioral networks recovered millions with RecoupOps.
“RecoupOps changed our entire economic unit model. We stopped writing off denials under $150 and recovered $2.1M in revenue our clients thought was gone forever. We took on 14 new practices this quarter without hiring a single additional biller.”
“Before RecoupOps, our billers were drowning in 80-page surgical charts trying to craft appeal letters. With RecoupOps, the clinical packet is 95% complete before a biller even opens it. Our physicians are thrilled that their hard work is finally getting paid.”
“Commercial insurers were systematically denying legitimate mental health care, counting on the fact that small practices can't afford to fight back. RecoupOps leveled the playing field overnight. We recovered nearly $700K with zero staff burnout.”
Built for Protected Health Information (PHI) from day one.
Healthcare revenue cycle operations demand uncompromising security. We execute a Business Associate Agreement (BAA) before data moves, enforce 100% US data residency, and maintain zero-retention, zero-training commitments with LLM model infrastructure.
Connects seamlessly with your existing revenue cycle infrastructure
Frequently Asked Questions
Everything you need to know about RecoupOps's denial recovery workflow, pricing, and integrations.
No. RecoupOps is designed to coexist seamlessly with your existing PM/EHR and clearinghouse stack (such as athenahealth, Epic, Kareo, Availity, and Waystar). We ingest 835 remittances in read-only mode, classify denials, and stage appeal packets without disrupting your core billing operations.
See what your denials are actually worth.
Send us one month of 835 remittances under a signed BAA. We'll show you exactly how many dollars are recoverable — before you pay anything.