Cut Your Denial Rate from 8% to Under 3%
AI-powered denial analysis, priority scoring, and appeal automation — purpose-built for mid-market healthcare providers. Recover revenue your team doesn’t have time to fight for manually.
The Denial Problem Is Getting Worse
Payers are denying more claims every year. Manual processes can’t keep up.
8%
Average denial rate across the industry
For a 200-physician group processing $100M annually, that's $8M in jeopardized revenue every year.
$262B
Denied annually in the U.S.
Payers deny over a quarter trillion dollars in claims each year, and the number keeps growing.
63%
Of denials are never appealed
Most organizations lack the staff, time, or data to appeal effectively, leaving billions unrecovered.
Everything You Need to Win Every Appeal
From ingestion to resolution — NexaClaim covers the complete denial lifecycle.
Automated EDI 835 Ingestion
Upload EDI 835 remittance files or connect to your clearinghouse. NexaClaim auto-parses every CARC/RARC code and creates denial records instantly.
< 60 sec to ingest
AI Root Cause Analysis
Multi-model AI analyzes each denial against clinical documentation, payer history, and industry benchmarks to pinpoint the true root cause.
94% root cause accuracy
Recovery Probability Scoring
Every denial gets a 0–100% recovery score based on clinical evidence strength, payer appeal history, and regulatory support.
87% prediction accuracy
Smart Priority Queue
Denials are auto-ranked by dollar amount, recovery probability, and filing deadline. Your team always works the right denial first.
3x faster resolution
Payer Pattern Detection
AI identifies systematic payer behaviors — when a payer starts mass-denying a specific CPT code, you know before it costs you.
Catches 89% of payer spikes
Bulk Resubmission Engine
Identify related denials with the same root cause, fix the issue once, and resubmit hundreds of claims simultaneously.
10x team throughput
CARC/RARC Intelligence
450+ denial codes mapped to specific resolution workflows, regulatory citations, and appeal arguments. No guesswork.
450+ codes mapped
Filing Deadline Alerts
Automated alerts 30, 14, and 7 days before appeal deadlines. Never lose a winnable denial to a technicality.
Zero missed deadlines
How It Works
From denial to recovery in four automated steps.
Ingest
Upload EDI 835 files or connect your clearinghouse. Claims and denials are parsed and categorized automatically within 60 seconds.
Analyze
AI runs root cause analysis on every denial, assigns recovery probability, and prioritizes your worklist by expected dollar recovery.
Act
Your team works AI-prioritized denials with pre-built resolution workflows. Generate appeals, resubmit claims, or write-off with one click.
Learn
Every resolved denial trains the model. Payer patterns update in real time. Your recovery rate compounds month over month.
Real Revenue Recovered. Measured Results.
From physician groups to health systems, NexaClaim delivers measurable denial reduction within 90 days.
Challenge
Denial rate had climbed to 9.2% with a team of 6 managing 12,000+ monthly claims. Staff were missing appeal deadlines.
Result
Denial rate dropped to 2.8% in 90 days. $2.1M recovered in year one. Appeal filing rate went from 31% to 92%.
$2.1M recovered
Challenge
Surgical procedure denials were being written off without appeal due to complexity of clinical documentation requirements.
Result
78% of previously written-off surgical denials successfully appealed. Net collection rate improved from 93.1% to 97.8%.
97.8% net collection rate
Challenge
Medicare Advantage denials were up 34% year-over-year with no systematic tracking of payer-specific denial patterns.
Result
Identified that 67% of MA denials shared 3 root causes. Fixed upstream coding issues. MA denial rate cut by 58% in 60 days.
58% MA denial reduction
Average denial rate reduction
Appeal success rate
Faster denial resolution
Average year-one recovery
Works With Your Existing Systems
NexaClaim integrates with the tools your team already uses — no rip-and-replace required.
HIPAA Compliant
BAA available
SOC 2 Type II
Certified
99.9% Uptime
SLA guaranteed
Live in 14 Days
Zero integration cost
Frequently Asked Questions
Stop Leaving Revenue on the Table
Join 50+ physician groups who have recovered millions in denied revenue with NexaClaim AI. Get started in 15 minutes with a free denial audit.
No credit card required. See results in under 24 hours.