Intelligent Triage Engine

Every denial read and understood — not just listed.

Traditional billing software gives you an overwhelming list of 500 rejection codes. RecoupOps transforms raw remittances into prioritized, winnable appeal opportunities.

Automated 835 Remittance Parsing and CARC Triage Architecture
Multi-Source Ingestion

Reads raw 835 ERA files in milliseconds.

Connect via clearinghouse API, secure SFTP folder drop, or direct PM/EHR sync. RecoupOps ingests electronic remittances the moment they are generated, parsing complex CLP segments and CAS adjustments without manual data entry.

  • Supports HIPAA 5010 835 / 837 transaction standards
  • Automated clearinghouse 277CA acceptance tracking
  • Zero biller lag time
EDI 835 Segment Parser:
CLP*CLM-94821*1*4850.00*0.00*4850.00*12*REC849201~
CAS*CO*197*4850.00~
LQ*HE*N54~
✔ Parsed: Prior Auth absent for CPT 29881 · Status: Appeal-Worthy

The Six Upstream Root Causes

RecoupOps rolls 400 individual denial codes into six fixable operational categories:

1. Prior Authorization & Referral Gaps (CO-197, CO-15)
2. Medical Necessity & LCD/NCD Criteria (CO-50)
3. NCCI Bundling & Modifier Mismatches (CO-97)
4. Coordination of Benefits & Eligibility (CO-22, CO-27)
5. Missing Clinical Data or Pointers (CO-16, CO-11)
6. Timely Filing Expirations (CO-29)
Root-Cause Intelligence

Fix the upstream leak, not just the single claim.

By grouping denials by upstream root causes rather than isolated claim IDs, RecoupOps alerts your front-desk and clinical documentation coordinators to recurring registration or coding errors before the next billing cycle.

Test Triage in Demo Sandbox
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.

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