Autonomous Denial Recovery Platform

One unified system for the entire denial lifecycle.

From the millisecond an electronic 835 remittance arrives to the day the overturn check deposits into your merchant bank account.

RecoupOpscare Denial Triage and Recovery Dashboard Interface
End-to-End Walkthrough

The lifecycle of a single denied claim.

See how a typical $4,850 surgical denial (CO-197: prior auth missing for an unplanned intraoperative procedure) is transformed into recovered cash.

01
835 Remittance Arrival
Clearinghouse automated SFTP ingest
UnitedHealthcare transmits an 835 ERA file denying CPT 29881 under CARC CO-197 and RARC N54. RecoupOps parses the EDI segment in under 80 milliseconds.
02
Root-Cause Triage & Scoring
Expected Value (EV) evaluation
RecoupOps correlates the claim with original pre-cert records, flags an intraoperative CPT addition, checks CMS-0057-F benchmarks (67% MA overturn rate), and assigns a high-priority expected value score of $3,250.
03
Clinical Appeal Letter Drafting
AI synthesis with LCD citations
RecoupOps drafts a 3-page formal appeal citing LCD-34981 emergency intraoperative exception clauses, indexing surgeon dictation notes, and compiling Exhibit attachments into a unified PDF.
04
Human Approval & Timely Filing
1-click review & portal dispatch
Lead biller approves the pre-compiled package with one click. RecoupOps logs the 180-day filing deadline and dispatches the packet to the UHC Document Vault.
05
Overturn & Cash Recovery
Reprocessed payment advice
Payer reconsiders and overturns the denial on re-review. Check deposits for $4,850. RecoupOps updates internal overturn telemetry and closes the claim.
Clean Operating Boundaries

What RecoupOps Does NOT Do

Clear scope boundaries build trust in healthcare revenue cycle management.

No Original Claim Billing

We do not create or submit initial 837 encounters. That remains in your core PM/EHR.

No Clearinghouse Replacement

We connect downstream from Availity, Waystar, Optum, and Change Healthcare.

No Medical Coding Decisions

We do not assign initial ICD-10 or CPT codes for clinical encounters.

No Legal Advice

Our templates provide clinical and administrative dispute frameworks for biller review.

Zero Long-Term Contracts · Instant 835 Ingest

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.

HIPAA BAA on Every Plan Live in Under 48 Hours 14-Day Full Production Sandbox