Your claims aren't denied because the system is broken. They're denied because nobody has the hours to fight back.

AI catches what your team misses. A person who does this for a living catches what AI misses. Revenue you already earned, worked back claim by claim.

BAA provided
HIPAA compliant
Works alongside your biller
Medical clinic reception area

Up to 65% of denied claims are never reworked or appealed.
That's money you already earned, leaking out every month. We work it back.

You already did the work.

The patient was seen. The diagnosis was made. The claim was filed.

Then it comes back denied.

And it sits there. In a queue. In a spreadsheet. In someone's "I'll get to it Friday" folder. Friday becomes next Friday. Next Friday becomes next month. Collection rates drop sharply past 90 days. After 120, most practices just write them off. Revenue you earned but will never touch.

This isn't a software problem. Your EHR works. Your clearinghouse works. The problem is there aren't enough hours in the day for your team to work a denial queue, submit prior auths, call insurers, and keep the practice running.

So the money leaks out. Every month. Quietly.

11.8%
All-payer initial denial rate in 2024 (Experian), up from 10.2% in 2020
65%
Of denied claims never get reworked or appealed (Change Healthcare)
70%
Of appealed claims get overturned when providers fight (Premier Inc.)
45-70 min
Time to properly appeal one denial (MGMA)

AI processes the volume. Humans catch the exceptions.

Pure AI companies hallucinate CPT codes and submit bad appeals. Pure VA companies can't keep up with volume. We do both. Together.

Medical team reviewing patient data together

AI handles this

  • Parses 835 remittances and categorizes denials by reason code
  • Flags appealable vs non-appealable claims automatically
  • Drafts appeal letters with correct clinical language
  • Tracks aging on every denied claim
  • Identifies patterns (recurring denials, payer behavior)

Your billing specialist handles this

  • Reviews complex denials AI flagged as high-risk
  • Edits and approves appeals before submission
  • Escalates systemic issues to your practice
  • Prioritizes which claims to fight first
  • Makes the judgment calls AI shouldn't make

Together: Denials get worked. Prior auths get submitted. Claims get paid. Your team goes home at 5.

Concern: "Will this replace my biller?"

No. Your biller keeps their job. We work the queue they don't have hours for, and nothing goes out without human review and your sign-off.

Concern: "What if the AI makes mistakes?"

Every high-stakes appeal gets human review before it reaches you. The AI does the grunt work. A person catches the exceptions. Nothing ships without your sign-off.

Concern: "Is this just another AI hype product?"

Most "AI billing" tools are chatbots with a stamp: nobody catches the wrong code before it ships. Pure-human services can't handle the volume. We pair AI speed with human judgment. See a sample analysis ↓

Three steps. Ten minutes of your time per week.

STEP 01

Send us your denial data

Through our secure upload portal. It is encrypted and access-logged, and it goes live only after our BAA is countersigned. Never by email. If you don't know where your 835 files live, we'll find them together in 5 minutes on a call.

STEP 02

We find the money and draft the appeals

AI sorts every denial. A specialist reviews every high-stakes claim. You get ready-to-submit appeal letters, usually within 3-5 business days.

STEP 03

You review and submit

Final sign-off is yours. About 10 minutes per week of your time. Works with any system: Athena, Kareo, AdvancedMD, Epic, eClinicalWorks, and anything else that exports 835s (they all do).

Nothing changes for your staff. No retraining, no migration, no new tools to learn. The appeals arrive ready-to-submit; your team just approves and sends.

Flat monthly fee. No percentage of collections.

You're already losing money on unappealed denials. The question isn't whether you can afford this. It's whether you can afford to keep losing it.

Cancel anytime. No annual contracts. If we're not finding money, fire us.

Starter

$750/month
  • Up to 2 providers
  • Denial X-Ray of your full queue at onboarding
  • Every denied claim worked, weekly
  • Ready-to-submit appeal letters (practice submits, monthly cap of 20)
  • Email support

Practice

$2,500/month
  • Unlimited providers
  • Everything in Growth, plus:
  • Dedicated denial recovery team: AI plus a named human specialist
  • Done-with-you submission: we prepare each batch, you approve, we submit under your NPI
  • Denial prevention playbook: stop the recurring ones at the source
  • Custom payer templates
  • Phone + priority support

For comparison: a full-time denial specialist hire runs $37.5-50K/year in salary alone (plus benefits and management), and each manual appeal costs about $43 and 45-70 minutes of staff time. Your own denial volume, verified on the analysis call, is the number that matters.

Start with a Denial X-Ray: $497

Not ready to commit? Start with a full analysis of your denial queue. Every appealable dollar, quantified and reviewed by a human, within 72 hours. If you start a sprint within 30 days, the full $497 is credited toward your first month. And if the X-Ray finds less than one month's fee in appealable denials, we refund it in full.

Founding practices: first 3 sprints at 50% off

We're early, and we say so. The first three practices get the full sprint at half price for the first 90 days. In exchange: permission to share your (anonymized) recovery numbers once results land. Same guarantee, same terms, honest trade.

How billing works

Flat monthly invoice, billed after your first month (card or ACH). No setup fees. No percentage of collections, ever. No annual contract. Cancel anytime; if we're not finding money, fire us.

One guarantee, stated plainly.

The Recovery Guarantee

If we don't recover at least 2x your monthly fee (measured in dollars payers actually paid on appeals we prepared, tracked in your Recovery Ledger) within 90 days of your first appeal submission, your next 2 months are free.

One cooperation requirement: submit the prepared appeals we deliver within 30 days. That's it. No clock-pause clauses, no hidden conditions.

"Recovered" means a payer-PAID dollar on a previously denied claim, appealed with a letter we prepared, confirmed in your remittance data. Guarantee applies to practices with $10K+/month in denied claims (below that, the target scales proportionally). Applies to pilots on the same terms, measured against the pilot fee actually paid.

Here's what a Denial X-Ray looks like.

This is output from our parser running on a synthetic 835 remittance file, built from real CARC-code distribution data. It's the same analysis we run on your data: no practice's actual claims, no PHI, no hypothetical testimonials.

$47,200
Total denied dollars in one quarter
89
Denied claims, 61 flagged as appealable
$31,400
Estimated recoverable value

Top 3 denial reasons found:

  • CARC 50 (non-covered services): 23 claims, $18,100. Many appealable with medical necessity documentation.
  • CARC 197 (precert/authorization absent): 18 claims, $14,200. Appealable if auth was obtained but not on file.
  • CARC 16 (claim lacks information): 12 claims, $8,900. Appealable with corrected claim submission.

61 of 89 denied claims were appealable. $31,400 sitting in the queue, none of it being worked.

This is the kind of analysis we run on your denial data. Free. Before you pay a cent.

Questions practice owners ask.

Is this HIPAA compliant?

Yes. We operate under a signed BAA (Business Associate Agreement) before any 835 file is shared; nothing moves before it's countersigned. All data is encrypted in transit and at rest, and files reach us only through our secure, access-logged upload portal. We are a HIPAA Business Associate under 45 CFR 160.103.

Does this replace my current biller?

No. We work alongside your existing biller; nothing about their role changes. We take the denial queue nobody has hours to work, and nothing goes out without their eyes or yours on it.

How fast will I see results?

On the initial call (30 minutes), we walk through exactly what we'll look for in your denial data and how the recovery math works for a practice your size. Once you share an 835 file through our secure portal under BAA, we categorize every denial within 72 hours. First appeals are typically ready within 3-5 business days. Recovery depends on payer response times (30-45 days average).

What if the AI makes a mistake?

Every high-stakes appeal gets human review before it reaches you. The AI does the first pass. A person catches what the AI gets wrong. You do final sign-off before anything is submitted. Nothing ships without your approval.

Does this work with my EHR?

Works alongside Athena, Kareo, AdvancedMD, Epic, eClinicalWorks, and any system that exports 835 remittance files. No migration. No retraining your staff. If your system generates 835s (and it does), we can work with it.

What's the catch with the guarantee?

No catch, and no fine-print maze. If we don't recover at least 2x your monthly fee (in dollars payers actually paid on appeals we prepared) within 90 days of your first appeal submission, your next 2 months are free. The only requirement: submit the appeals we deliver within 30 days. "Recovered" means payer-paid, confirmed in your remittance data. One scope note: the 2x target applies to practices with $10K+/month in denied claims (we verify that together on the call); below that it scales proportionally.

Who's behind this?

OmoiOS is run by Kevin Hill, an AI infrastructure engineer who has spent his career building production AI systems (workforce platforms, multi-tenant SaaS). You work directly with the person building the AI, not an account manager. We cap at 5 concurrent practices so every appeal queue gets personal review. Book a call and meet the person you'd actually be working with.

Revenue dashboard showing recovered claims data

See exactly how much money is hiding in your denied claims.

Book a 15-minute denial analysis. We look at your actual denial data together, on the call. If the numbers don't make sense, we part as friends.

Book your denial analysis call