Stop denials before they happen.
InvisaClaim checks claims before submission, flags denial risk, verifies eligibility, catches NCCI conflicts, identifies missing data, and guides your team toward cleaner, faster reimbursement.
Cleaner claims. Fewer denials. Faster payment.
InvisaClaim is not just an appeal tool. It is built to stop preventable denials upstream with eligibility checks, prior authorization awareness, NCCI analysis, modifier guidance, documentation prompts, payer-pattern scoring, and audit-ready workflows.
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
Your contracts say 150% of Medicare.
Your payments don't always agree.
Every 835 ERA that arrives gets compared against the contracted rate on file. When payment doesn't match, the case is flagged — automatically, before a biller has to notice. No quarterly audit. No spreadsheet reconciliation. No revenue quietly walking out the door.
Catch every dollar your contract entitles you to.
InvisaClaim's underpayment engine runs the moment an 835 lands. It calculates expected payment using your contracted rate basis — % of Medicare, % of billed charges, or flat rate — and compares it against what the payer actually remitted. Material gaps surface as flagged cases. Trivial rounding differences stay quiet.
- Automatic recalculation on every ERANo manual reconciliation. No quarterly audits. The platform checks every claim against its contract at ingest time.
- Material-gap thresholdsConfigurable dollar and percentage thresholds prevent inbox flooding from $0.40 rounding differences.
- CMS-sourced expected valuesCalculations use the live Medicare Physician Fee Schedule by locality — not stale assumptions or estimates.
- On-demand recompute when rates changeUpdate a payer's contracted rate and every affected case re-evaluates within seconds.
- Per-payer underpayment exposure dashboardSee which payers owe you what, ranked by dollar exposure and ready to support contract renegotiation.
Every payer. Every rate. Every network status.
Your contracts shouldn't live in a folder no one opens. InvisaClaim's contract layer captures each payer's rate basis, percentage, network designation, and renewal date — tied to the provider NPI it belongs to, ready to drive appeal language, underpayment detection, and GFE estimates automatically.
| Payer | Basis | Rate | Network |
|---|---|---|---|
Cigna Healthcare | % of Medicare | 150% | INN |
UnitedHealthcare | % of Medicare | 140% | INN |
BCBS Federal | % of Medicare | 135% | INN |
Aetna PPO | % of Billed | 60% | OON |
Humana Medicare Adv. | % of Medicare | 100% | INN |
Contracts that drive workflow, not paperwork.
InvisaClaim treats each payer-provider contract as a live data record. Change a rate and the platform recomputes underpayments. Mark a payer out-of-network and appeal letters automatically pivot to NSA, UCR, and state-law framing. Every downstream workflow inherits the contract's truth.
- Three rate bases supported% of Medicare allowable, % of billed charges, or flat per-CPT rates — captured per payer and provider.
- INN / OON network designationNetwork status drives which appeal framework, regulatory citations, and reimbursement logic applies.
- Inline edit with instant recomputeUpdate a rate from the platform settings and every affected case re-evaluates against the new contract.
- Contract renewal trackingSurface upcoming renewals as leverage opportunities — ranked by exposure, urgency, and payer performance.
- Bulk fee schedule importUpload payer fee schedules as PDF, CSV, or Excel. AI extracts and structures rate data automatically.
Built on AI that understands healthcare.
Generic chat assistants weren't built for prior authorization criteria, payer policy citations, or appeal-grade clinical writing. InvisaClaim is built on healthcare-tuned models with HIPAA-compliant infrastructure, CMS-sourced reference data, and physician-validated reasoning patterns.
Clinical-grade reasoning
Appeal generation runs on healthcare-tuned large language models with HIPAA-compliant infrastructure and a Business Associate Agreement in place. The platform reasons about CARCs, modifiers, NCCI edits, and payer policies — not generic billing prose.
- HIPAA-compliant model providers under BAA
- Physician-validated appeal patterns
- Source-cited clinical reasoning
Grounded in authoritative sources
Appeal letters and PA arguments cite real, current data — not training-set knowledge that may have drifted. The platform retrieves live CMS coverage policies, NCCI edits, ICD-10 codes, and NPI registry records at the moment of generation.
- CMS Physician Fee Schedule by locality
- NCCI Policy Manual citations
- ICD-10 + CPT live code lookup
Auditable & HIPAA-aligned
Every AI-generated artifact carries lineage. Which model produced it, what context was passed in, what sources it cited, when it was reviewed, and by whom. Built so revenue cycle leadership and compliance can both sign off without crossing fingers.
- Full prompt and response audit trail
- Encrypted PHI handling end-to-end
- SOC 2 Type II · HITRUST-ready posture
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 |
Run the whole billing operation in one place.
InvisaClaim isn't only a denial engine — it's the workspace billing teams and RCM companies operate inside all day. Multi-practice management, a dedicated denial workbench, in-context collaboration, and rules-based task routing turn a queue into a coordinated operation.
Denial Workbench
A dedicated surface for working denials at volume — group by payer, denial code, dollar value, or aging, and move from extraction to appeal without leaving the screen.
- Bulk triage by CARC/RARC and exposure
- One-click into the matching appeal flow
- Live status as cases move to resolution
Practices & Providers
Built for billing companies and MSOs managing many practices at once. Each practice and provider NPI is isolated, with per-practice performance breakdowns rolled up to one view.
- Multi-tenant — many practices, one login
- Per-practice and per-provider performance
- NPI-scoped data isolation throughout
Team Threads & Messages
Keep the conversation attached to the case. Team Threads and Messages let billers, managers, and providers coordinate in-context — no parallel email chain, no lost decisions.
- Case-anchored discussion threads
- Direct messages across the workspace
- Context that travels with the claim
Task Routing
Assign cases to the right team member automatically. Rules-based routing by payer, specialty, dollar value, or workload keeps ownership clear and nothing orphaned.
- Rules-based auto-assignment
- Ownership, reassignment, and audit log
- "Assigned to me" personal work view
Claims History
A complete, searchable record of every claim across its lifecycle — submission, status checks, payments, denials, appeals, and closures — for any patient, provider, or payer.
- Full lifecycle timeline per claim
- Search by patient, payer, CPT, or status
- Claim status checking (276/277)
Lien Management
Track workers' comp and personal-injury liens alongside standard claims — balances, statuses, and recovery tied to the same patient and case record.
- WC and PI lien tracking
- Balance and recovery status per lien
- Tied into the patient case timeline
From prevention 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.
Prevent denials before the claim is ever submitted.
Pre-Check AI runs every claim through denial-risk analysis before submission and every appeal through success prediction before you spend an hour drafting. The fastest path to recovery is the one that doesn't get denied twice.
Eligibility verification, NCCI edits, missing-data warnings, modifier guidance, and payer-pattern risk scoring — all running in seconds against the claim sitting in front of you.
Predict appeal success. Identify the fastest path to recovery.
Every claim, every appeal — scored before it ships. Pre-Check AI surfaces the modifier you forgot, the NCCI bundle that will get rejected, the medical-necessity language that worked on this payer last time, and the appeal angle most likely to win given the denial code.
- Pre-submission denial-risk scoringRun claim details through AI-powered risk analysis. Get a percentage score and a ranked list of issues to fix before you submit.
- Real-time eligibility verification (270/271)Optum-backed eligibility runs at point-of-order. Coverage, deductible, prior-auth requirements — surfaced before service.
- NCCI edits & CCI-1 bundle analysisCatch procedure-to-procedure conflicts before submission. Modifier suggestions surface inline when an edit is bypassable.
- Missing-data warningsRequired fields, payer-specific quirks, taxonomy mismatches — flagged before the claim ships, not after it's denied.
- Appeal-success predictionBefore you spend an hour drafting, see the predicted win rate for the appeal — based on payer, denial code, and clinical context.
- StrongMedical-necessity language matched 4 prior wins on this payer+ 18 pts
- AddModifier 59 likely required — NCCI edit on 64483 + 27447+ 9 pts
- RiskBCBS Federal: 22% of CO-50 denials require peer-to-peer−6 pts
A dedicated workspace for payer reimbursement intelligence.
Every contract benchmarked against the live CMS Physician Fee Schedule. Every payer ranked by recoverable exposure. Every renewal scored by negotiation leverage. The Medicare tab is where revenue cycle leadership goes to find money.
YTD underpayment exposure, payers below contract, CPT-level recovery status, contract renewal countdown, and one-click negotiation briefs — all on one screen.
Reimbursement by payer
Compare what you're paid vs your contracted rate. Underpaid rows surface biggest dollar gaps first, ranked across every payer with claim volume.
| Payer | Actual | Contract | Gap |
|---|---|---|---|
| Cigna Under | 102.8% | 150% | −$689 |
| Anthem No Con | 0.0% | — | — |
| Humana No Con | 0.0% | — | — |
Negotiation targets
Top payers ranked by recoverable exposure. Generate a board-ready brief — actual % of Medicare, contracted %, point gap, case count — to bring to your next renewal meeting.
Contract renewal countdown
Payers ranked by negotiation leverage — a function of exposure, volume, and renewal urgency. Know which renewals to push hard on, and which to let ride.
Underpayment aging
Recover early. Underpayments older than 90 days have lower collection probability and may exceed appeal deadlines. CPT-level recovery status, quarterly % of Medicare trend, and locality coverage round out the picture.
Where your chart lives,
your revenue follows.
For health systems running on Epic, InvisaClaim connects via FHIR R4 to your Epic environment — pulling the clinical evidence, prior auth context, and claim history needed to extract denials, draft appeals, and generate NSA packets without ever leaving the patient chart.
Bidirectional FHIR R4 sync. SMART on FHIR launch. Workqueue-aware routing. The result: billers stop copy-pasting between systems, and revenue-cycle leadership stops reconciling two sources of truth.
SMART on FHIR launch
Open InvisaClaim in-context from any patient chart. Token-scoped auth, no second login, no swivel-chair workflow.
Bidirectional chart sync
Pull clinical notes, problem lists, and prior imaging for appeal evidence. Push appeal status and recovery outcomes back to the patient record.
Workqueue-aware routing
Mirror Epic Resolute and Tapestry workqueues. Cases stay assigned to the right team, status updates flow back to the host system.
Real-time eligibility & auth
270/271 eligibility and 278 prior-auth checks fire from within the chart at point-of-order — denial risk surfaces before the order is signed.
Compliance & audit trail
HIPAA-aligned, end-to-end encrypted, with full lineage from chart event to claim outcome. Built to pass internal audit on day one.
Connected to the rails revenue already runs on.
InvisaClaim plugs into the clearinghouses, payer networks, EHRs, and back-office tools your team already uses — so claims, eligibility, ERAs, and payments flow without a parallel system of record.
Priced per provider.
Scales with your practice.
Every plan is billed per provider NPI, month to month. Start with a 7-day free trial — a credit card is required to begin, and you can cancel anytime before the trial ends. Add modules as you grow, from a solo specialist to a multi-practice billing company.
Starter
Core denial management for the solo or small specialty practice ready to stop leaving appeals on the table.
- Denial Extraction & Structured Capture
- Payer-Specific Appeal Generation
- Patient Profiles & Case Timeline
- Payment & Underpayment Tracking
NSA / IDR Suite
The full No Surprises Act and arbitration workflow for out-of-network exposure.
- Notice & Consent
- Reconsideration Letters
- NSA Eligibility Determination
- IDR Deadline Rracking & Escalation
- Arbitration Packet Generation
- GFE Support & Documentation
- Federal Resources
- No Recovery Fees or Percetages to InvisaClaim
Integration
Connect to clearinghouses, payer networks, and your EHR. For practices ready to automate the data flow end to end.
- Clearinghouse & Payer Connectivity
- Real-Time Eligibility (270/271)
- Epic FHIR & EHR Integration
- Athena Health Integration
- Change/Optum, Waystar, Availity Integration
- Lien Management & Rracking
Compliance Suite
The full command center — Pre-Check AI, Medicare intelligence, and the compliance posture larger groups require.
- Everything in Integration
- Pre-Check AI
- Pre-Submission
- Medicare Reimbursement Intelligence
- NCCI / CCI edits & Modifier Guidance
- Contract & Renewal Management
- Lien Management & Tracking
- Audit Trail & Compliance Reporting
Enterprise
For multi-practice billing companies and health systems running InvisaClaim across many providers.
- Everything in Compliance Suite
- Multi-Tenant Practice Management
- Per-Practice Performance Reporting
- Task Routing & Team Collaboration
- Dedicated Spport & Onboarding
- Custom Integrations & SLAs
- Volume-Based Pricing
Stop denials before they happen — and recover the ones that still slip through.
Start a 30-day free trial and put your first denials, pre-auths, and underpayments through the platform — or book a walkthrough with the team.