How it works
Exactly what happens, step by step.
This is the whole mechanism: how your data reaches us, what we build with it, who signs what, and when money moves. Written for the person who gets asked “so what does this actually involve,” so they can answer without booking a call.
01
It starts with your denial export.
Most billing systems have a denial or rejection report, the one your biller pulls to see what came back unpaid. Some make you build the export the first time. Either way that export is our entire starting point: claim number, date of service, payer, denial code, billed amount, status. No format to match and no fields to fill in; whatever your system prints is what we want. The first pull is the longest one. After that it's routine.
From it we find the long tail: the small-dollar denials still inside their appeal windows, where a manual appeal would cost more than the claim brings back. We come back with that as a candidate list before anything is built. You cross off whatever you want crossed off, for any reason or none. Then, every week, one page lists what we've prepared, and nothing goes until you've ticked it.
02
A private, encrypted upload page.
We send you a link. It's a private, encrypted page that belongs to your practice. There's no application to install, no integration to set up, and no credentials for anyone to manage. Your team drags your denial export onto it and closes the tab. Files travel from the browser straight into encrypted storage.
When we have read the export, we come back with the specific claims we intend to appeal and the supporting notes each one needs. Those go up the same way. That is the entire data relationship: the minimum necessary, and nothing beyond it.
- No access to your EMR or PM system
- No software installed anywhere
- No logins for your staff to keep track of
- Notes only for the claims we flag
03
How each appeal gets built.
The system reads the denial, pulls the insurer's own published rule for it (published, and written not to be read), and checks both against what is already in the chart. Where the claim is recoverable it drafts a corrected claim or a written appeal that cites the rule, the chart language that meets it, and nothing that isn't in your records.
AI does the reading and the drafting, which is what makes a claim this small worth working at all. It isn't the last step. A person reads every packet against the chart and the rule before it reaches your sheet. Your own staff send each released packet from your own system, under your own login, with our instructions attached; we never hold your credentials. We never phone an insurer and we never escalate by voice. Everything is written, so there is a record of what was argued and what came back.
04
Clinical sign-off, on the same weekly sheet.
Most of what we prepare is administrative: bundling, modifiers, eligibility, authorization technicalities. None of it needs clinician involvement at all. When an appeal does make a clinical argument, your clinician approves it before it's filed, every time.
Your clinicians are never asked to sign off one claim at a time.
Clinical sign-offs ride the same weekly sheet: one page listing each appeal's claim, the argument being made, and the chart basis for it, signed together in one sitting, at whatever time your clinician chooses.
A few minutes a week, and plenty of weeks have nothing clinical on the sheet at all. In those weeks there is nothing for your clinician to sign.
05
The monthly rhythm.
The insurer pays your practice directly, into the same account they use today. Nothing about your remittance changes, and Revalis never appears between you and your money.
Each month you get a plain-English statement: every claim we worked, what it was denied for, what came back, and what is still open. Then we invoice our share, after the insurer has paid you, never before, and never out of the payment itself.
06
Canceling.
Cancel any time after the first sweep, which runs about six to eight weeks. We stop taking on new claims, hand you a final statement of everything still in flight, and return or destroy what we hold per the BAA. Claims already filed either run to resolution and are invoiced at the same rate, or come back to you as finished packets, your call. Nothing new enters. No notice period, no fee.
The burden, row by row
Your part, and ours.
Every claim anyone makes about how little work this is should be checkable. Here is the whole of it, with what each row costs you stated on the row itself.
Your part
Our part
Sign two documents.
A mutual BAA and a short service agreement, both of which arrive already filled in.
The BAA is the standard HIPAA formality that makes it legal for us to look at your numbers. It protects you and commits you to nothing.
Your time · About 15 minutes, once
We draft both and send them to you.
Nothing moves, and no data is requested, until they come back signed.
Send the monthly denial export.
Drop it on the private, encrypted page we send you, then close the tab. There is no format to match and no fields to fill in.
Claim number, date of service, payer, denial code, billed amount, status. Whatever your system already prints is what we want.
Your time · About 10 minutes a month
We read every denial on it.
For each one we pull the insurer's own published rule and check it against what the chart already says. Then we come back with the candidate list, and you cross off anything you want crossed off.
Pull notes for the claims we flag as clinical.
We name the specific claims and the specific notes. Typically 5 to 10 claims a month for a practice your size.
Only the portion of the note that supports the appeal. We never ask for a full chart export, and we never ask about a patient whose claim we aren't working.
Your time · About 30 to 45 minutes a month
Most appeals never reach you at all.
Bundling, modifiers, eligibility, authorization technicalities: the majority of the volume is administrative, and administrative appeals are built from the denial export and the claim data alone. Those never ask you for a note.
Tick the weekly sheet, then send the packets.
One page listing what we've prepared, one line of argument each, and which notes we need. Cross off what doesn't go, no reason needed. Your clinician signs the clinical lines on the same sheet. Then send the released packets from your own system, under your own login; each comes complete, with its instructions and its deadline.
Your time · 10 to 15 minutes a week on the sheet, a few of them your clinician's, plus a few minutes per packet to send; you set how many a week
We hold every packet until it's ticked.
Nothing is ready to send until it's ticked on that page, and anything clinical waits for the signature as well. Weeks with nothing to send have no sheet.
Deposit the insurer's checks.
The insurer pays your practice directly, into the same account they use today. Nothing about your remittance changes.
Your time · None
We prepare, track, report, and invoice last.
Every appeal is read by a person before it reaches your sheet. We hand you each one complete, with its instructions and its deadline; you send it. We track the deadline, send you a monthly statement, and invoice our share only after the insurer has paid you.
Your total
About ten minutes for the export, ten to fifteen minutes a week on the sheet, thirty to forty-five minutes of notes, a couple of minutes a packet to send, and the odd question in between. No single number, because you set how many packets land in a week; the sheet shows the count before you commit to it. Each row above costs what it says; if one costs you more, the row is wrong and we want to hear about it.
What goes out under your name
Every packet has a cover sheet. Here's one.
A person reads it before it goes out, and your clinician signs this page before anything clinical does.
Appeal packet · cover sheet
Sample · synthetic dataRevalis
Appeal of denied claim
Prepared for Cedar Ridge Dermatology · filed by the practice
Patient
REDACTED — SAMPLE
Claim number
••••4508
Date of service
11/12/2025
Payer
Payer A
Denial code
CO-4 · modifier inconsistent with procedure
Billed / at issue
$243.00
Appeal deadline
05/28/2026 · 180 days from remittance (29 Nov 2025)
Argument type
ADMINISTRATIVE — CODING
Basis of appeal
Procedure billed with modifier 25 on the same date as a separately identifiable E/M service. Payer medical policy REIMB-014 (rev. 09/2025), section 3.2, permits separate reimbursement where the E/M service is significant and separately identifiable. Chart note of 11/12/2025 documents an unrelated presenting complaint, independent history, exam, and assessment. Requesting reprocessing under the payer's own published policy. No new clinical assertion is made beyond what the record already documents.
Enclosures
1Payer appeal form, completed
2Original claim and remittance advice
3Office note, 11/12/2025 (minimum necessary excerpt)
4Payer policy REIMB-014 §3.2, printed with revision date
Clinician approval — required before filing
This packet is held until the treating clinician approves it in the weekly sign-off batch. Administrative appeals with no clinical assertion are marked N/A and filed on review.
Filed under the practice's name, on the practice's letterhead · Revalis does not contact payers by telephone
Audit trail reference SAMPLE-0000-A · retained for the life of the engagement
Illustrative format only. Synthetic practice, synthetic claim, payer shown as “Payer A,” policy number invented for the example. Revalis has no client records to publish, so this shows the shape of the work product, not anyone's actual appeal.
What lands on your desk each month
The statement, in full.
One page, plain English, every claim accounted for, including the ones that did not come back.
Monthly recovery statement
Sample · synthetic dataRevalis
Monthly recovery statement
| Claim | DOS | Payer | Denial | Billed | Recovered | Status |
|---|---|---|---|---|---|---|
| ••4471 | 11/04/25 | Payer A | CO-97 bundling | 187.40 | 187.40 | Paid |
| ••4508 | 11/12/25 | Payer A | CO-4 modifier | 243.00 | 243.00 | Paid |
| ••4530 | 11/19/25 | Payer B | CO-45 fee schedule | 126.80 | 126.80 | Paid |
| ••4612 | 12/02/25 | Payer B | CO-16 missing info | 112.25 | 112.25 | Paid |
| ••4638 | 12/05/25 | Payer C | CO-11 dx mismatch | 198.55 | 198.55 | Paid |
| ••4655 | 12/09/25 | Payer C | CO-197 no auth | 287.10 | — | Appeal filed |
| ••4702 | 12/17/25 | Payer A | CO-151 frequency | 154.00 | — | Not recoverable |
| Claims worked this period | 38 |
| Recovered and posted to you | 2,847.15 |
| Still open with payers | 1,204.60 |
| Your share, already paid to you by the payer | 1,850.65 |
| Revalis fee · 35% of recovered | 996.50 |
| Invoiced this month | 996.50 |
Invoiced only after the payer has paid you · Full line detail and audit trail available on request
Illustrative format only. Synthetic practice, synthetic claims, payers shown as A/B/C. Dollar figures are examples of the claim sizes this service works, not a projection of what any practice will recover.
Questions
The things practices actually ask.
What does this mean for our biller, or our billing company?
Their queue doesn't change. We work only the denials below the line where a manual appeal costs more than it returns; your team keeps everything current and keeps working the claims worth working.
Your billers aren't doing anything wrong. The math just doesn't work for a human. We built a system where it does. When a claim costs more in staff time to appeal than it's worth, writing it off is the right call, and anyone who says otherwise has never done their own billing at 11pm. We work a different set of claims than they do, and we never touch theirs: nothing with any activity inside the window you set, which is 90 days unless you say otherwise.
Which claims qualify?
Small-dollar denials, roughly the $100–300 band, still inside their appeal windows. Primarily commercial insurers.
We triage the export and come back with a candidate list before we touch anything. You cross off whatever you want crossed off, for any reason or none: a claim your team is already on, an insurer relationship you would rather not test, a patient whose history you know. Then, every week, one page lists what we've prepared, and nothing goes until you've ticked it.
How do you get paid?
After you do. Our fee is 35% of what comes back in the first sweep and 30% of what comes back after your start date. You keep the rest, and if nothing comes back there is no fee.
We never receive or handle your funds. The insurer keeps paying your practice exactly as they do today, and we invoice afterward, for our share only.
How long does any of this take?
The first sweep runs about six to eight weeks. It goes out in batches rather than all at once, so the first appeals are filed well before the last ones are built.
Insurers then adjudicate on their own clock, typically 30 to 60 days, and nobody has yet found a way to hurry them. The first money usually posts to your account about two months after the first filing. After the sweep, new denials are worked on the same monthly rhythm as they occur.
Do you call our insurers?
Never. Everything is written, built from your own records and the insurer's own published rule, and sent by your own staff from your own system with our instructions attached. Nobody calls anyone on your behalf, and nobody escalates by voice.
Do you use AI?
Yes, and here is exactly where. AI reads every denial and drafts every appeal, because a person doing that by hand on a $180 claim costs more than $180. It doesn't file anything, doesn't contact insurers, and doesn't sign anything.
A person reads every packet before it goes anywhere, and right now that person is me, which I'd rather tell you than have you find out. Your clinician signs anything that makes a clinical argument.
Is our data used to train AI models?
No, never. Not our models, and not a vendor's. Your data is used to work your claims. That is the entire permitted purpose, and it is written into the BAA. See the full security page →
Could this get us audited?
Nothing we prepare is a new claim or a new clinical assertion. Every appeal argues from the insurer's own published rule and from what your chart already documents, on the insurer's own appeal form, under your practice's name. Appealing a denial is the ordinary, expected use of a process insurers built and staff themselves.
What draws scrutiny is a different thing entirely: upcoding, documentation changed after the fact, or a clinical argument the record does not support. We do none of those, which is why a person checks each packet against the chart before it is filed and your clinician signs anything clinical. Where a claim is not supported, we mark it not recoverable and leave it alone.
The legal detail, including the agreement and the BAA in full, is on the page for your attorney.
How much staff time does this take?
No single number, because you set how many packets you send in a week; the ledger above prices each part on its row: about ten minutes to send the export, ten to fifteen minutes a week on the sheet, thirty to forty-five minutes pulling notes for the clinical claims we flag, and a couple of minutes a packet to send
Can we cancel?
Any time after the first sweep, which runs about six to eight weeks. No notice period and no termination fee, and no clause that keeps us working your claims after you have said stop.
What's the catch?
We're early. I'm onboarding the first practices now, and I'd rather say so than have you find out. Three of them, to start, because I read every packet myself. There's no wall of logos on this site because there is nothing honest to put on it yet.
What you are risking is a couple of hours of staff time a month, plus the sending, which you size on the sheet. There is no fee, no software, no subscription, and no money changes hands unless an insurer has paid you first.
Who do you work with?
Independent practices, typically 3–5 providers, billing commercial insurance. Currently dermatology and behavioral-health groups. If you are outside that and the math still looks right, say so and I'll tell you whether it's worth your time.
The next step costs nothing.
Two things: a mutual BAA, which is the standard HIPAA paperwork that makes it legal for us to look at your numbers, and a denial export from your system.