Three agents. One rule: the human decides.
Appelo prepares the paperwork end-to-end — then hands every output to your team for review and approval. Here's what each agent actually does.
Reads the denial. Drafts the winning appeal.
Appelo classifies the denial reason, pulls the supporting documentation from the chart, and drafts a payer-specific appeal that cites the exact medical-necessity criteria — ready for your review.
- Classifies the denial code and root cause
- Pulls conservative-care notes, imaging, and op reports from the chart
- Cites only real, curated payer policy — it can't invent a policy number
- Verifies every claim against your documentation before you approve
Catches the gaps that cause denials — before you submit.
Prevention beats recovery. Appelo scans each claim or prior-auth packet against payer requirements — tuned to the denial drivers that hit orthopedics hardest — and flags what's missing, with a suggested fix your team accepts or dismisses.
- Enforces ortho conservative-care timelines — the #1 total-joint PA denial driver
- Catches global-period modifier errors (24, 58, 78, 79)
- Flags NCCI/CCI bundling conflicts and CPT/ICD-10 mismatches
- Suggests the fix — your team accepts or dismisses
Assembles the packet. Tracks it. Preps the peer-to-peer.
Appelo builds each prior-auth packet against the payer's checklist, tracks submission status, and — when a peer-to-peer is needed — preps a clinical summary and talking points for your physician.
- Builds the packet against each payer’s requirement checklist
- Tracks submission and approval status in one place
- Preps a peer-to-peer pack: clinical summary + talking points
- Your team confirms and submits
3-point clinical summary + medical-necessity talking points ready for Dr. review.
Everything between the remittance and the deposit.
One operating system across the claim lifecycle — intake, prevention, appeals, recovery, and the analytics leadership runs on. Every output stays grounded, checked, and yours to approve.
Intake
Get every claim in — no clearinghouse integration.Drop in your remittances
Upload an 835 remittance or 837 claim file and Appelo reconciles every claim automatically — claims posted as submitted, payments recorded, denials routed to the appeal workspace with their CARC reason codes; each denial arrives already classified, drafted, and risk-scored.
Works from your inbox
A provider can email new records — even an X-ray or PDF — to your intake address. Appelo matches it to the right denial (or asks which one), attaches the file as evidence, pulls just the payer-required section, revises and re-checks the appeal, and emails back a summary.
Prevent
Stop denials before they happen — starting the moment the patient is seen.Point-of-care plan check
The moment a clinical note is written — or a dictation is uploaded; Appelo transcribes the audio in-VPC — it reads the planned course of action and checks it against that patient's payer: conservative care required first, prior authorization, documentation the policy will demand. The care team gets the next actions to take, and a one-click prior auth pre-filled from the check itself. A conflict caught at the point of care never becomes a denial, and never needs an appeal letter.
Denial-risk scoring
Before you submit, Appelo predicts how likely the payer is to deny and surfaces the top fixes to improve your odds.
Skip the prior auth
Appelo tracks which payers gold-card your practice — when a payer waives prior auth for a procedure, it flags it so you skip the submission entirely, and watches your approval rate so you know what it takes to earn gold-card status with the rest.
Appeal
Drafted, grounded in current policy, and checked.Agentic Claim OS
Appelo knows the next move on every claim — the instant a denial is recorded, its agents classify it, draft the appeal, grounding-check it, and score the denial risk in the background, so it arrives ready for review with its recommended next action and a full agent-activity trace. Nothing is ever submitted without your approval.
Knows when to appeal, resubmit, or recover
Appelo reads each denial and recommends the right play — draft a grounded medical-necessity appeal, correct & resubmit the coding in athenahealth, or recover an underpayment — so you don't appeal a claim that should just be corrected, or leave money on a contract underpayment. You always decide.
Live policy intelligence
Appelo continuously tracks the payer and CMS policy that drives denials — NCCI/MUE coding edits, coverage criteria, fee schedules — and versions every change. Letters and denial-risk are grounded in what's current, with the real citation, and the workspace shows when each source was last refreshed.
Documentation-content verification
Appelo turns the payer's medical-necessity bar into a checklist and verifies each statement against the actual text of your chart documents — the operative report, PT notes, imaging reads — not just their file names, quoting the exact line that backs each claim (and flagging the one that contradicts it). A statement the record doesn't fully back becomes an open documentation gap with a readiness score, and denial risk is tied to it. Close the gap right there — confirm the wording, ask Appelo to soften it to match the chart, or attach an addendum — and Approve & submit stays locked until every gap is closed or confirmed (an override is logged to the audit trail).
Case copilot
Ask Appelo about any open case and get an answer grounded in that case's letter, grounding check, and documents — why a statement is flagged, what would strengthen the appeal — always with its source cited. It informs; it never decides or submits.
Bundle similar denials
When several appeals share a payer and denial reason, Appelo bundles them so you can resolve the common decision once — soften the wording or attach the supporting source — and it applies the fix across the whole group, each re-checked and still awaiting your approval.
Minimum-necessary attachments
Appelo pulls only the section a payer requires — e.g. UnitedHealthcare's imaging read — not the entire office note. Less PHI, exactly what they asked for.
Recover
Recover every dollar — denials and underpayments.Underpayment detection & recovery
Every paid claim is benchmarked against your contracted rate as the remittance lands — when a payer pays below contract, Appelo flags the variance automatically and, with one click, drafts a recovery letter anchored on the contracted rate and the exact shortfall. Silent underpayments don't slip by.
Full claim lifecycle
Track every claim end to end — submitted, accepted, paid, underpaid, denied, appealed, closed — with every stage timestamped on the claim's timeline and denials flowing straight into the appeal workspace.
Analyze
Show leadership exactly where the money is.Executive dollars-at-risk analytics
Leadership sees the revenue-cycle picture in dollars, not just rates — what's at risk now, what's recoverable at your overturn rate, and where the money sits by payer and procedure (click through to those claims). A benchmarked KPI spine, ortho service-line lenses, a prior-auth funnel, and modifier/global-period denial drivers are built in.
Board-ready monthly review
A one-click, print-ready monthly summary for leadership: approvals and successful appeals trending up while time-to-decision falls — the velocity Appelo adds shown as patients getting care sooner and revenue recovered faster.
Per-location trends
Every claim is tagged to the service location it came from, so analytics compares your sites side by side — denial rate, net collection, and dollars at risk per location — surfacing where one location is trending worse and needs a closer look.
Peer benchmarking
See how you compare to your specialty cohort — percentile on denial rate, net collection, days in A/R, and overturn rate, plus the dollars to reach the median. Filter the cohort by payer, claim type, and practice size. De-identified aggregates only; cohorts under 11 practices are never shown.
Learns from every outcome
When a payer's decision on an appeal is recorded — overturned or upheld — Appelo automatically updates that payer's playbook from the now-complete outcome history, so the next appeal to that payer is stronger. The playbook stays within your own practice's data.
Trust
Defensible by design.Full audit trail
Every AI draft, human approval, and agent run is timestamped and exportable for your compliance review.
Overnight work queue
A scheduled agent drafts newly denied claims overnight, grounding-checked and waiting for morning review. Nothing is ever submitted on its own.
Payer playbooks
Appelo learns what overturns each payer's denials from your own history, and applies those tactics to new appeals — once your team promotes them.
Every workflow ends with your approval.
That's the whole point. See it on your own denials.