Turn denials, pre-auths, and payments into revenue.
InvisaClaim is the AI-powered operating system for medical billing teams and RCM operators — collapsing denial extraction, payer-specific appeals, pre-authorization, patient profiles, and payment tracking into one auditable workflow.
Healthcare loses revenue not to fraud, but to friction — the quiet hours spent reconciling denial codes, chasing pre-auths, and rewriting appeals.
Most billing teams operate across six to twelve disconnected systems. Denial letters live in inboxes. Pre-auths live in payer portals. Patient context lives in the EHR. Recovery work lives wherever someone remembered to write it down. InvisaClaim collapses that surface area into one operating layer.
Six modules.
One operating layer
for revenue cycle.
Each module replaces a workflow that today lives across spreadsheets, email threads, payer portals, and tribal knowledge. Adopt module by module, or run the complete RCM command center.
Denial Extraction
Upload EOBs, denial letters, or 835 ERA files. Extract every claim detail — payer, patient, CPT, ICD-10, CARC/RARC — into a structured record with confidence scoring.
- CARC / RARC and payer-reason capture
- Patient, payer, claim, CPT, ICD-10, DOS extraction
- Missing-data warnings before submission
Payer-Specific Appeals
Generate appeal letters tuned to the payer, denial reason, service line, and clinical evidence. Built on payer policy patterns — not boilerplate templates.
- Medical-necessity, authorization, timely filing
- Embedded clinical-evidence references
- Copy, download, version, save to case
Pre-Authorization
Track authorization requests, attach supporting documentation, monitor payer responses, and surface follow-up deadlines before they expire into denials.
- Submitted, pending, approved, expired states
- Clinical evidence checklists per CPT
- Deadline routing and escalation
Patient Profiles
Every claim, denial, appeal, pre-auth, document, and payer note tied to the patient it belongs to. A single timeline replaces a dozen folders.
- Case timeline and correspondence history
- Insurance and payer policy details
- Document library per patient
Payment Tracking
Watch billed, allowed, paid, denied, underpaid, and outstanding amounts move across providers, payers, and patients in one ledger.
- ERA/EOB matching and reconciliation
- Underpayment detection vs. contracted rates
- Recovery pipeline and forecast view
NSA & IDR Workflow
Manage No Surprises Act eligibility, IDR deadlines, GFE support, and arbitration packet generation — built to the federal process, not adapted from a generic queue.
- Eligibility determination and audit trail
- Deadline tracking with escalation
- Arbitration packet generation
A queue that makes the next move obvious.
Cases are organized by dollar value, deadline, payer, category, and ownership — not by whoever happened to log them first. Billers know what to work, in what order, and why.
| Case | Patient · Payer | Issue | Deadline | Amount | Status |
|---|---|---|---|---|---|
| IC-48201 | Ramirez, J. Aetna · PPO |
CO-50 medical necessity | 3 days | $4,850 | Appeal ready |
| IC-48198 | Okonkwo, A. UnitedHealthcare |
Pre-auth · CPT 72148 | 5 days | $2,140 | Pending payer |
| IC-48193 | Chen, M. BCBS · Federal |
Underpayment detected | 12 days | $3,210 | Action needed |
| IC-48187 | Bellamy, R. Cigna |
Timely filing dispute | 8 days | $1,980 | Drafting |
| IC-48181 | Park, S. Humana · Medicare |
ERA matched · paid | — | $1,875 | Closed paid |
| IC-48174 | Albright, T. Aetna · HMO |
NSA eligible · IDR prep | 21 days | $6,200 | In review |
From intake to resolution.
Five stages, one auditable trail. Every claim moves through the same workflow whether it came in as a denial letter, an ERA file, or a payer portal export.
Intake
Upload denial letters, EOBs, chart notes, ERA / 835 files, or pull from clearinghouse.
Extract
Structured capture of payer, patient, CPT, ICD-10, denial reason, and dollar amount.
Prioritize
Cases routed by dollar value, deadline, payer pattern, and assigned ownership.
Generate
Appeals, pre-auth follow-ups, NSA packets, and payer correspondence drafted in context.
Resolve
Track submissions, payments, underpayments, denials, and closures end-to-end.
Catch authorizations before they become denials.
Most authorization-related denials trace back to a missing piece of documentation or a deadline that quietly slipped. The pre-auth suite makes both visible while there is still time to act.
Authorization intake
Capture CPT, ICD-10, payer, provider, requested service, and required documentation in one structured record.
Status tracking
Submitted, pending, approved, denied, expired, and follow-up-needed states with a clear audit trail.
Clinical support
Organize chart notes, medical necessity criteria, and follow-up letters tied to the case.
Deadline control
Payer response dates, expiration dates, appeal windows — escalated before they expire.
Built for the systems billing teams already use.
Manual upload workflows for teams getting started. Direct integration with clearinghouses, EHRs, accounting systems, and payer data sources for teams ready to scale.
“We replaced four spreadsheets, two payer portals, and a denial-tracking inbox with one queue. Our team works twice as many cases per day, and the cases that used to slip through the cracks don't.”
Plans that scale with your recovery work.
Start with denial management automation. Add payer integrations as your team grows. Add the full Surprise Billing & NSA/IDR compliance suite when the federal workflow demands it.
Starter
For practices getting started with denial management automation.
- Denial Classification & Routing
- AI Appeal Draft Generation
- Workflow Dashboard
- Basic Analytics
Integration
For teams that want full automation and payer integrations.
- Everything in Starter
- 835 ERA Auto-Import (Change/Optum)
- Pre-Check AI Denial Prediction
- AthenaHealth Integration
- QuickBooks Online Sync
- Eligibility Verification (270/271)
- Claim Status Checking (267/277)
Compliance Suite
Everything in Integration + full No Surprises Act & Surprise Billing suite.
- Everything in Integration
- Surprise Billing Compliance Suite
- Eligibility Checker (270/271)
- Notice & Consent
- Docusign Integration
- Real Time Pre-Authorization
- QuickBooks Integration
- GFE Generator
- IDR Tracker & Deadline Alerts
- Federal Arbitration Letters
- NSA Reconsideration Workflows
- Waystar Integration
Enterprise
For larger organizations needing scale, controls, and tailored support.
- Everything in Integration
- EHR Integration via HL7/FHIR
- EPIC & AthenaHealth Integration
- Advanced Payer Analytics
- Multi-Location Dashboards
- Security Documentation
- Dedicated Account Support
One clean system for denials, pre-auths, patients, and payments.
See InvisaClaim with your own claims data. We'll set up a working pilot in under an hour and show you exactly where the recovery is hiding in your queue today.