Recourse
Most Denials Are Recoverable. Most Are Never Worked.
Recourse reads the payer response, identifies why the claim was denied, groups denials by root cause, and ranks what is left by what is actually recoverable. Then it drafts the appeal, and a biller decides whether to send it.
The problem is triage, not effort
A denial queue is not a list of tasks, it is a list of bets. Some are worth twenty minutes and some are worth nothing, and the reason so much recoverable revenue is written off is that nobody has time to tell which is which.
Recourse analyses payer responses, identifies the denial reason from the codes and the claim context, and groups similar denials by root cause so the underlying problem becomes visible rather than the individual symptoms.
It then prioritises by recoverable value and likelihood of recovery, drafts an appeal from the denial reason, the clinical documentation, the claim and the applicable payer policy language, and prioritises A/R follow-up. A biller reviews, edits and submits.
Capabilities
What's included
Work the denials worth working, first
Denial reason identification
Payer responses are read in context, so the reason reflects the claim rather than just the remittance code.
Root-cause grouping
Denials are grouped by underlying cause, which is what turns a rework queue into a fixable process problem.
Appeal drafting
Appeals are drafted from the denial reason, the clinical documentation, the claim and the applicable payer policy language.
Remittance data extraction
Structured payment and adjustment data is extracted from electronic remittances, PDFs and other documents.
Why it matters
The outcomes practices actually measure
We are evaluated on the numbers that change in your operation, not on features shipped or tickets closed.
- Less manual denial work
- Reading the remittance, finding the documentation and writing the letter is most of the labour, and all of it is draftable.
- Staff pointed at real recovery
- Prioritising by recoverable value means the hours spent on the queue land where money actually comes back.
- Clinical and financial reconnected
- The denial is worked against the documentation behind the original claim rather than against the claim alone.
- Root causes become visible
- Grouping turns two hundred individual denials into four upstream problems you can actually fix.
How it works
What working with us looks like
- 1
Identify the reason
Payer responses are analysed and the denial reason is identified from the codes and the claim context.
- 2
Group by root cause
Similar denials are grouped so the upstream cause is addressable rather than being reworked one claim at a time.
- 3
Prioritise the queue
Claims are ranked by recoverable value and likelihood of recovery, and A/R follow-up is prioritised the same way.
- 4
Draft, review, submit
An appeal is drafted from the denial reason, documentation, claim and payer policy. A biller reviews, edits and submits it.
Frequently paired with
FAQ
Recourse, frequently asked questions questions
- Does Recourse submit appeals by itself?
- No. It drafts the appeal. A biller reviews and edits it and decides whether and when to submit.
- What does it need to work?
- Denial worklists, A/R aging, payment and remittance data, and access to the clinical documentation behind the original claim.
- Can it work our existing A/R?
- Yes. Prioritisation by recoverable value and likelihood is most useful on an aged backlog, which is exactly where triage has broken down.
- Who uses it?
- Medical billers, A/R teams, RCM managers, billing companies and practice administrators.
We're here to help
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