The idea

“Every US hospital billing department employs 'denial management' specialists whose only job is to appeal rejected insurance claims. The average hospital loses 3–5% of net revenue to unrecovered denials. The work is formulaic: pull the EOB, identify the denial code, match it to the correct appeal template, attach the clinical notes, refile within the payer's deadline. It is document assembly with a clock on it. Existing AI medical billing tools (Waystar, Olive, Availity) are sold to hospital CFOs on 2-year enterprise contracts and take 9 months to implement. They don't sell to the 6,000 independent physician practices and specialty groups (5–50 providers) who collectively process $180B in claims annually and run denial management on spreadsheets and shared inboxes. We sell directly to the billing manager, not the CFO. $299/month flat, no contract, connects to whatever PM software they already use (AdvancedMD, Kareo, athenahealth) via read-only API. Identifies denied claims, generates the appeal letter in the correct payer-specific format, and files it before the deadline. No implementation project. No IT involvement. The distribution channel that the enterprise vendors structurally cannot use: medical billing associations (AAPC has 200,000 members, HFMA has 70,000). Billing managers, not CFOs, are the buyers. A $500 conference sponsorship reaches more qualified buyers than a $50,000 enterprise sales rep. Why now: CMS issued updated denial appeal regulations in January 2025 that changed the required format and deadline windows for Medicare Advantage plans — the fastest-growing payer category. Every practice using a manual process is currently non-compliant with the new format requirements and doesn't know it.”