Recovr AI
AI Agent that doesn't just recommend. It recovers. Our autonomous agent drafts and submits appeals with clinical justification, files corrected claims, and takes action to get you paid. No handoffs. No delays. No revenue left behind.
What the agent actually does
Action, not just analysis. The agent does the work a denial specialist would do — only in seconds.
Appeals & letters
Drafts and submits appeal requests to payer portals with clinical justification and supporting attachments — and generates information-request letters when data is missing from a provider or payer.
Corrected claims
Identifies field-level corrections, presents them for guided before-and-after review, validates the claim — including confirming the destination payer can receive it — and submits the replacement.
Payer-portal actions
Creates reconsideration tickets with reason codes, disputed amounts, and attachments. Reads payer documents with vision-capable AI, uploads supporting documentation, and researches payer policy and billing guidelines in real time.
Recovery Paths
Not every denial wants an appeal. For each one, the agent selects the motion with the best expected value — and tells you why.
Refile — File a corrected replacement claim referencing the original.
Reroute — Send the claim to the payer or plan it should have gone to — including coverage the agent found through insurance discovery.
Appeal — Argue the denial, with clinical justification and payer-policy citations attached.
What agent case result contains
Root cause
Identified in plain language, not a code.
Recovery motion
The recommended path, chosen from five.
Confidence score
So teams work the highest-value denials first.
Field corrections
The exact fields to change, with before and after.
Drafted letters
Appeal and request letters, ready for review.
Cited sources
The policies, data, and precedents behind every conclusion.
Autonomy with guardrails
Recovr AI is built for a regulated industry. Autonomy is always chosen, never imposed — and every action, human or agent, runs inside the same safeguards.
Sign-off, by rule
Nothing reaches a payer without human approval — unless an Autorun Rule you authorized says otherwise. Reviewers accept the proposed correction, edit it, or decline it entirely.
Locked fields, cited evidence
Details that must carry over from the original claim untouched — provider identity, claim reference numbers — cannot be altered, by anyone. Every corrected value is grounded in the claim record, the payer's response, or an authoritative source, and anything worth double-checking is flagged on the approval screen.
Knows when not to act
Before proposing anything, the agent checks the claim's current standing with the payer — if it was already corrected and paid, it says so instead of filing a duplicate. When a fact can't be verified, it holds the claim and tells your team exactly what to confirm. Every proposal, approval, decline, and submission is logged with timestamp and attribution.
Autonomy you configure
Full autonomy is never the default. It is a rule you write — and the agent can help write it.
Rules that match your book — Trigger the agent automatically on denials matching your criteria: CARC, RARC, payer, CPT, modifier, place of service, or status code. When several rules match, the most specific one wins.
Watch before you automate — Enable a rule in monitor mode to see what it would have done before committing it to full autonomy.
Your instructions, not ours — Attach payer- or scenario-specific instructions to any rule, overriding the agent's default behavior where your book demands it.
Playbooks the agent writes itself — From your approved historical cases, the agent drafts its own recovery instructions — your team's judgment, encoded and repeatable.
It learns your playbook
Every analysis lands in a worklog with a full lifecycle — new, follow-up, approved, closed. Reviewers can chat with the agent about any record, with the complete claim context preserved. And every approved analysis becomes a training example: the agent gets measurably better on your payers, your CPT mix, and your denial patterns — not someone else's.
In production, operators have approved 98.9% of the recommendations they reviewed.
Network Connections
Payer integration
Recovr AI connects directly to payer systems so the agent can act — not just recommend. Dedicated APIs where the volume is; out-of-the-box clearinghouse coverage for every other payer.
Optum / UHC Direct API
Real-time claim search; claim detail with service lines, adjustments, and payer documents; reconsideration and appeal submission with attachments; ticket history; eligibility and benefit verification.
Availity multi-payer network
Eligibility & coverage (270/271), claim status (276/277), service review & prior authorization (278), and payer enrollment verification across Availity-connected payers.
Stedi network — every other payer
Out of the box, no per-payer setup: real-time eligibility (270/271), claim status (276/277) with automatic retry against replacement payers, insurance discovery, and coordination-of-benefits checks across the 3,500+ payers on the Stedi network — plus corrected-claim submission through the clearinghouse pipeline