The Claim Operating System for specialty practices.
From the moment a remittance lands, Appelo works every claim end to end — catches denials before they happen, drafts and grounds the appeal, recovers underpayments, and shows leadership exactly where the money is. Every output, your team approves.
Aetna · CO-197 · drafted
UHC · 2 documentation gaps
Cigna · overturned
The work is winnable. There's just too much of it.
Prior auth and denials drain hours your team doesn't have — so winnable revenue gets written off instead of appealed.
Sources: AMA 2024 prior-authorization survey; published claim-rework and appeal-overturn benchmarks. Figures are illustrative of the burden, not a guarantee.
One operating system for the whole claim lifecycle.
Every stage ends the same way — Appelo prepares, your team approves. Nothing is ever submitted on its own.
Remittances & records in
Drop in an 835 remittance or 837 claim file — or let providers email records to your intake address. Appelo reconciles every claim, posts payments, routes denials to the queue, and flags underpayments. No clearinghouse integration.
Catch denials before they happen
The moment a claim is drafted, Appelo scans it against payer rules — ortho-aware, with conservative-care timelines, global-period modifiers, and NCCI/CCI checks — and flags the fixes before you submit.
Denials, drafted and grounded
A denial arrives already classified, drafted, grounded in current payer/CMS policy, and risk-scored. Unsupported claims are flagged and must be acknowledged before you approve.
Underpayments, not just denials
Every paid claim is benchmarked against your contracted rate. When a payer pays below contract, Appelo flags the variance and drafts a recovery letter anchored on the exact shortfall.
Show leadership where the money is
An executive view in dollars — at risk and recoverable — with a benchmarked KPI spine, ortho service-line lenses, a board-ready monthly review, and how you compare to your specialty peers.
Drafted by AI. Approved by your team.
No black-box decisions. No clinical or coverage call is ever automated. Appelo does the preparation; your people make every decision.
Payers use AI to deny. Appelo is the AI that answers back — in the open.
Most physicians believe payers' AI is driving more denials, and those automated decisions are hard to challenge because no one can see the reasoning. Appelo flips that: every appeal is grounded in real payer policy, checked against your chart, and shows its work.
Sources: AMA February 2025 prior-authorization physician survey; Health Affairs and Stanford on the opacity of payer AI determinations. Transparency claims describe Appelo's design.
Orthopedics-first. Built for specialty revenue cycle.
Orthopedics has the widest prior-auth surface area of any specialty — every imaging study, surgery, injection, and therapy course is its own approval process. Appelo starts there, and the same engine works wherever paperwork stands between care and payment.
What your practice gets back.
See what you could recover.
Run a conservative estimate in two minutes, or talk to us about your denials.