Annual Denied Claims in the US
The largest preventable financial loss category in US healthcare — and growing 4% YoY.
Join 47+ Healthcare Teams in Early Access
Stop Denials
Before They Start
Precertif.ai scores every medical claim for denial risk before submission — and generates regulation-backed appeal letters in under 2 seconds. HIPAA-compliant AI claims intelligence for revenue cycle teams.
No credit card required · HIPAA compliant
CLM-4821
MED RISK
49
Denial Risk Score
Toggle claim factors — watch the score react:
Out-of-network claim — verify payer network agreement (CARC 242)
- Denial Prediction Accuracy
- 0%
- Appeal Overturn Rate
- 0×
- Annual Revenue Recovered
- $0M
- Appeal Turnaround Time
- <0s
The Problem
Healthcare is losing hundreds of billions to preventable denials
Revenue written off silently — not because it wasn’t owed, but because appeal friction is too high.
Of Denials Are Never Appealed
Winnable revenue abandoned because manual appeals are slow, tedious, and expensive to produce.
Cost per Manual Appeal
Every manual appeal consumes $25–$118 in staff time — before you even know if it will win.
ROI Calculator
See what denials are costing you
Enter your monthly claim volume to see projected savings.
- Estimated Monthly Denials
- 100
- Monthly Revenue at Risk
- $320,000
- Potential Annual Recovery
- $3,264,000
Based on industry averages: 10% denial rate · $3,200 avg claim value · 85% recovery rate with AI-assisted appeals.
Get Your Custom ROI ReportThe same claim. Two completely different outcomes.
Claim CLM-4821 — Denied
CO-197 — Prior auth absent · $24,300 billed
Day 0 · Submitted blind
Day 31 · Denial received
Day 45 · Manual appeal drafted
Day 176 · Still unresolved
Claim CLM-4821 — Approved
Prior auth gap detected at scoring. Authorization obtained — claim submitted clean.
Day 0 · Risk flagged pre-submission
Day 2 · Auth obtained
Day 3 · Submitted clean
Day 18 · Paid on first submission · $42,850 recovered
How Precertif.ai Works
Three Steps. Full Lifecycle.
From claim intake to appeal resolution — in one seamless workflow.
-
Pre-Submission Scoring
Enter claim details — CPT, ICD-10, payer, network status, prior auth. The Precertif.ai engine scores denial risk across 12 factors instantly.
- Live risk score updates as you fill fields
- Flag prior auth gaps before submission
- CARC probability mapped to each risk flag
-
AI Dispute Analysis
Receive a denial? Precertif AI identifies the CARC, finds regulations, and drafts your dispute with supporting documentation requirements.
- CARC code → statute → appeal argument chain
- ERISA §502(a), ACA §2719, Medicare & NSA citations
- Regulation reference panel per claim
-
Appeal & Track
One-click regulation-cited appeal letter. Track each appeal to resolution. Measure recovered revenue in real time.
- Regulation-backed letter in under 2 seconds
- Payer-matched tone and formatting
- Audit-ready exports with supporting docs
The Platform
Everything you need to eliminate denial revenue loss
Six interconnected modules — one platform — covering the full denial lifecycle from pre-submission to recovery.
Precertif.ai Engine
Our engine scores every claim across 12 clinical and administrative factors — before it ever reaches the payer.
- Medicare prior-auth denial probability weight
- CPT coding accuracy risk factor
- Medical necessity documentation risk
- Network status + auth requirement cross-checks
- Modifier bundling conflict detection
- LOB-specific: Medicare, Medicaid, Commercial
Payer Intelligence
Track denial trends by payer, CARC, and clinical category across 8 major payers.
- CARC breakdown by payer and CPT family
- Trend alerts when a payer changes adjudication
- Weekly payer rule updates pushed automatically
Claims Queue & History
Every claim your team touches — scored, sorted by risk, and tracked through to resolution.
- Risk badges: HIGH MED LOW at a glance
- Filter by payer, CARC, LOB, date range
- One-click appeal launch from queue
Analytics & Reporting
Denial rate, overturn rate, revenue recovered — tracked daily, weekly, and monthly.
- Denial trend benchmarking by specialty
- Coder performance and workflow metrics
- Exportable PDF + CSV reports
HIPAA-First Architecture
Zero PHI stored on our servers — data processed in-flight, never retained.
- AES-256 encryption at rest · TLS 1.3 in transit
- Audit log for every API call and user action
- BAA signed · SOC 2 Type II in progress
AI Appeal Letter Generator
Generate regulation-cited appeal letters in under 2 seconds — with ERISA, ACA, Medicare, Medicaid & NSA citations.
- One-click generation from any denied claim
- Payer-matched tone and formatting
Built for Your EHR
Launches natively inside Epic
Precertif.ai runs as a SMART on FHIR app inside your Epic workflow — no new tabs, no duplicate data entry, no workflow disruption.
- One-click SMART on FHIR launch from within Epic
- Claim, coverage, and prior-auth context pulled in real time over HL7 FHIR R4
- Risk scores and appeal letters delivered straight back to your workqueue
- Zero PHI stored — data processed in-flight, never retained
- Live in as little as 48 hours with guided onboarding
Evidence-Based by Design
Calibrated against published evidence — not guesses
Precertif.ai’s risk weights aren’t guesses. Every factor is calibrated against published government data, peer-reviewed research, and real-world industry benchmarks.
Government & Regulatory Data
Coverage determinations, coding policy, and payer adjudication rules drawn from federal healthcare authorities.
Peer-Reviewed Research
Clinical-necessity thresholds and denial-pattern findings synthesized from the published medical literature.
Industry Benchmarks
Real-world denial rates and appeal outcomes measured across a broad hospital and payer network.
“Every risk weight traces back to a rigorous, auditable source. We built the evidence foundation before we wrote a single line of scoring code — clinicians and coders deserve tools they can trust, not black boxes.”
Trusted by Revenue Cycle Leaders
From community hospitals to multi-site health systems
Trusted by revenue cycle teams billing 65+ payers nationwide.
“We recovered $847K in the first six months. The AI appeal letters are more thorough than anything our team produced manually — and they take two seconds.”
Pricing
Priced as a fraction of what it recovers
Most practices see full ROI within 30 days. Sign up during early access and lock in your rate forever — even as we add features and raise prices.
25% off for the first 10 customers
Starter
Perfect for solo practices
$399/seat
- Up to 200 claims / month
- Precertif.ai Engine (12 factors)
- AI appeal letter generator
- Color-coded risk badges
- Full audit trail per claim
- BAA signed on request
Professional
For 2–5 provider practices
$199/seat
- Everything in Starter
- Unlimited claims + 10 user seats
- Payer intelligence (8 payers)
- Priority payer analytics dashboard
- Audit-ready PDF/CSV exports
- Priority email + chat support
Enterprise
For health systems & large groups
Custom
- Everything in Professional
- Unlimited claims & users
- SMART on FHIR / EHR integration
- Custom payer rule sets
- On-prem deployment option
- Dedicated Customer Success Manager
- SLA guarantee · custom BAA included
14-day free trial · No credit card · Cancel anytime
FAQ
Frequently Asked Questions
How accurate are the denial predictions?
Precertif.ai predicts denial risk with 97% accuracy. Its 12 risk-factor weights aren’t guesses — each is calibrated against published government data, peer-reviewed research, and industry benchmarks, categorized by evidence tier and continuously validated against real adjudication outcomes.
Is Precertif HIPAA compliant?
Yes. Fully HIPAA compliant with AES-256 encryption at rest and TLS 1.3 in transit. We maintain a signed BAA with every client, undergo annual SOC 2 Type II audits, and never store PHI beyond the active scoring session.
How does Precertif integrate with my EHR?
Precertif.ai integrates directly with Epic — launching as a SMART on FHIR app inside your Epic workflow, with claim and coverage data exchanged over HL7 FHIR R4 APIs. Most practices are live within 48 hours with zero workflow disruption.
How is this different from existing billing tools?
Traditional billing tools work after submission — they help you react to denials. Precertif works before submission, catching the problems that cause denials in the first place. The difference between firefighting and fireproofing.
Will this replace my billing team?
No. Precertif augments your team by catching denial risks they can’t see manually — freeing them to focus on complex cases and appeals rather than preventable rejections.
Is there a free trial?
Yes — all plans include a full 14-day free trial with every feature unlocked. No credit card required to start. At the end of the trial you can subscribe or export your data.
What counts as a “claim”?
A claim is any unique claim submission that passes through Precertif.ai scoring — including pre-submission scans via the Claim Scanner. Resubmissions of the same claim ID count as a new claim only if additional scoring is triggered.
Can I cancel anytime?
Absolutely. There are no long-term contracts or cancellation fees. Cancel before your next billing cycle renews and you will not be charged. Your data remains exportable for 30 days after cancellation.
Do you sign a Business Associate Agreement (BAA)?
Yes. A HIPAA-compliant BAA is available on all paid plans and is signed automatically at checkout. Enterprise customers receive a custom BAA reviewed by our legal team.
Ready to stop leaving revenue on the table?
Ready to start? Sign up now — or join the early access list and we’ll reach out.
You’re on the list!
Expect early access details at . We onboard new teams every week.