For county-funded agencies
A denial is a service the county or insurer refused to pay. Each one arrives as a code in a payment file. Someone has to read it, work out the cause, fix it and resend it before a deadline.
In practice, denials pile up in spreadsheets and email. Across healthcare, about half are never worked at all.
Denials come in from the payment files and county reports you upload, and from the Revenue check.
Each one gets a plain-English reason, the deadline for that county, and the next step that county expects.
You assign it to a person. They work it on a worksheet that keeps a record of what was done.
When a later payment arrives for the same service, the queue marks it paid, so you can tell a fixed denial from a resubmission still waiting.
Fictional example
A $120 denial for a credential mismatch is assigned to a biller, fixed in the county system, and marked paid when the next payment file shows it.
Part of the same live-site test with a made-up agency (175 of 175 checks), then deleted.
Still missing: a real agency’s 835s and county reports. A full year goes in by service month: each month holds up to 5,000 records.
Ready to pilot means built, switched on and tested end to end on our live site with a made-up agency. None has run on a real agency’s files yet. What works today
Any time: a look back over a whole year
Revenue checkReady to pilotFinds county money you earned but were never paid, and says what you can still fix and by when.
Before you bill
County claim checkReady to pilotCatches county rule errors on each service before it goes to the county.
Before the county reviews your charts
Audit checkReady to pilotReviews every chart the way a county reviewer would, not just a sample.
Month-end and year-end
Cost reportsReady to pilotSplits shared costs to each contract and drafts the cost reports your funders require.