Intelligence Layer
PayPredict
Identify and prioritize the denials that matter. PayPredict ranks every denial by what it is actually worth recovering and hands the shortlist to Recovr AI — so nothing stops at insight.
Three apps, one job: tell you which denials are worth working, in the order they are worth working, before the filing window closes.
01
Opportunity Finder
Find the denial patterns worth money, in the order they are worth it.
Most denial analytics tell you which codes fire most often. Volume is a poor proxy for value — a frequent denial on a routine panel can be worth less than a rare one on a molecular assay. Opportunity Finder prices every denial pattern instead of counting it, using the allowed amount your own remittances actually realize rather than billed charges payers never pay.
Priced at your realized rate — For any slice of the book, the platform counts procedures that reached adjudication without being paid and prices them at the average allowed amount that same slice collects when it does get paid. Not billed charges. Not a published fee schedule. Your own remittance history.
Ten dimensions that stack — Category, denial ID, denial reason, payer, benefit plan, CPT, modifier, diagnosis, physician, and client, drillable in any order. Start at the payer, drill into the CPT, then into the specific CARC and remark pair — the dollar value recalculates at every level.
The supporting numbers, not just the headline — Every slice carries pay ratio, average allowed amount, insurance payment, patient deductible, and other patient responsibility, with the Medicare rate shown next to each CPT. Pay ratio renders in red below 50%.
Built to be handed off — Open the underlying remittances from any slice, export the full table, or send a colleague a permalink that reproduces the exact drill-down. With a payer and a CPT both in view, one click asks the policy advisor about that specific combination.
02
Denial Worklist
The queue, ordered by what pays and what expires first.
Denials arrive as an undifferentiated pile. The Worklist turns them into buckets — one per denial code and payer combination — ranked by the total expected recovery sitting inside each. Open a bucket and the individual claims appear, ordered by timely-filing deadline, so the work that is about to become unrecoverable sits at the top.
Filtered by probability and by Timely Filing Limit— Set a recovery-probability floor, choose how many days remain before the filing limit, separate in-house from outsourced teams
Timely Filing Limit filter accepts negative values, turning the queue around to face claims whose filing window has closed. Most organizations write these off automatically. Our production record shows reversals are still achievable there.
The remittance, in place — Selecting a claim opens its explanation of benefits inline, with service lines, adjustments, and CARC and RARC detail, plus a one-click hand-off to the policy advisor on any individual procedure.
Live payer transactions from the claim — Run eligibility and benefits verification, insurance discovery for coverage the claim was never billed against, and coordination-of-benefits analysis that reports whether other insurance is on file, whether coverage periods overlap, whether services are covered twice, and which payer should be primary.
03
Claim Status Tracker
Find out what the payer did, without opening a portal.
Claims that were submitted and never came back are the quietest leak in the revenue cycle — no denial fires, no remittance posts, and nothing enters a denial queue. The Claim Status Tracker surfaces them, ranked by expected value, then checks their status directly with the payer.
What the payer's own system says — Current claim status, total charged, total paid, patient responsibility, remittance date, check number, and service-line detail. Where the payer reports a problem, the response carries the error code, its description, and the follow-up action the payer specifies.
Automatic replacement-payer retry — When the original payer cannot answer, from a routing change, a payer ID that no longer resolves, or an acquisition, the service identifies known replacement payers and retries automatically, reporting which one responded and recording every attempt.
Three failures, told apart — A payer that does not support electronic status checks, a provider not yet enrolled, and an enrollment still pending are three different problems with three different fixes. Most tools return one error. This one names which.
Never acting on a stale answer — Every result is stamped with the time it was retrieved and labelled live or cached. Cache entries invalidate automatically for the states that change — pending enrollment, processing errors, and claims the payer could not locate — and any check can be forced fresh on demand.