Problem Statement

A denied claim only becomes recoverable revenue if someone assembles the appeal and submits it before the filing deadline. ED downgrades, where a payer reduces the billed E&M level and pays less than the visit warranted, arrive as a steady stream that each require generating an appeal letter and submitting it through the payer portal, work that is repetitive enough to backlog yet directly tied to dollars left on the table. While these appeals sit unsubmitted, downgrades age toward the appeal deadline, and any that miss the window become permanent write-offs on revenue the organization had every right to recover.

Automation Solution

This automation processes ED downgrade appeal releases from an Epic workqueue, generates the appeal letter using native templates, and submits it through the payer portal.