Akeso AI ingests messy chart notes and payer denial faxes to generate citation-grounded appeal dossiers, peer-to-peer battle cards, and real-time patient status updates in under two minutes.
UHC_DENIAL_PT-8812.pdf • 8 pages · DERM_ENCOUNTER.pdf • 14 pages
“Denied: Step therapy required. Patient must fail Adalimumab and Methotrexate before IL-23 approval.”
Ingesting the 14-page chart & synthesizing clinical evidence…
APPEAL_PT-8812_L1.pdf • 6 pages + enclosures
The four pillars
Built for independent Dermatology, Rheumatology, Gastroenterology and Oncology practices — not for hospital IT departments.
Drag and drop multi-page PDFs, chart notes, or scanned faxes without a 9-month EHR integration project. No API keys, no IT ticket, no downtime.
Every drug failure, lab value, and contraindication is cited with clickable chart source tags, so nothing reaches a payer that isn't in the record.
Automate insurance hold calls and IVR navigation to retrieve claim status without burning coordinator hours on hold music.
Specialty pharmacy routing, copay assistance matching, and a 60-day renewal countdown so approvals don't quietly lapse.
The problem
Specialty denials are won on documentation, not persistence. Most clinics simply run out of hours.
Patients wait 3–6 weeks for life-changing biologics while disease progression worsens and flares escalate.
Prior authorization coordinators spend 15+ hours per week manually parsing 8-page denial letters.
Up to 40% of initial specialty rejections are never appealed due to lack of time and complex step-therapy mandates.
How it works
Average end-to-end time: under two minutes per case.
Drag & drop the insurer's denial letter or EOB alongside the patient's clinical encounter notes (PDF or scan).
Akeso isolates CARC/RARC rejection codes, matches tried-and-failed medications, and checks the payer's Clinical Policy Bulletins.
Review the editable, citation-backed appeal letter and download a structured, ready-to-fax PDF packet.
The platform
Beyond the appeal letter — every tool your team reaches for after a denial lands.
Printable 30-second rebuttals for the physician's peer-to-peer call.
Scores fail-first exemptions against payer policy and state statutes.
Secure e-fax or portal-ready export with a statutory deadline clock.
60-day re-authorization countdown so approvals never quietly lapse.
Preferred-product checks and grounded medical-exception overrides.
Copay & assistance enrollment plus buy-and-bill underwater alerts.
J-code reimbursement benchmarks per payer before you buy and bill.
Overturn rates, turnaround time and recovered revenue by payer.
What makes the output defensible when a payer — or a physician — pushes back.
Payer & PBM intelligence engine — Live coverage criteria and formulary-shift detection, with an ambiguity resolver for vague denial language.
Evidence grounding — Every clinical claim links back to a cited chart page; unsupported claims surface as gaps instead of being invented.
Clinical accuracy lab — Continuous benchmarking against a golden dataset for hallucination and citation accuracy.
Attestation & immutable audit trail — Clinician sign-off freezes the letter and its citations, with role-based staff access and a tamper-proof ledger.
Interoperability & fidelity monitor — Payer FHIR coverage-status checks plus OCR fidelity scoring on scanned denial faxes.
BAA governance & renewal control — Vendor agreement tracking with expiration reminders, versioned revisions, side-by-side diffs, guarded rollbacks and an exportable activity ledger — PHI transmission stays sandboxed until every agreement is in force.
Practice ROI calculator
1 to 15 providers
5 to 60 denials per month
Modeled on 1.4 coordinator hours per manual appeal and an average overturned biologic claim value of $4,200. Directional estimate — not a guarantee of outcome.
Staff hours saved monthly
~64 hours / month
Annual practice revenue protected
$318,000 / year
Akeso AI plan recommendation
Practice Pro Tier ($499/mo)
Specialty coverage
Clinical data points extracted
PASI and BSA severity scores, DLQI impact, documented topical corticosteroid and phototherapy failures, and dates of every prior systemic trial.
Maps documented topical and phototherapy failures against each payer's step-therapy ladder and rebuts "insufficient severity" denials with quantified scores.
Default citation set: AAD 2026 psoriasis & atopic dermatitis biologics guidelines
From the practices using it
“Biologic denials used to eat two full days of my week between the fax log and chart digging. Now the dossier comes back cited, and I only review it before it goes out.”
11 appeals/week handled by one coordinator
Danielle Ortiz
Practice Manager
Coastline Dermatology — 4 providers, Tampa FL
“The peer-to-peer card is what changed the calls. Our physician walks in with the payer's own bulletin language and the trial citations, not a printed chart note.”
Peer-to-peer prep down to 6 minutes
Marcus Whitfield
Prior Authorization Lead
Ridgeview Rheumatology — independent practice, Boise ID
“The underwater check caught two infusion starts that would have lost money at our acquisition cost. That alone paid for the year.”
$41K in at-risk margin flagged before scheduling
Priya Raghunathan
Revenue Cycle Director
Northbend GI & Infusion — 7 providers, Columbus OH
Before / after
Appeal turnaround
From denial fax received to a cited, payer-formatted dossier queued for physician attestation.
Blended overturn rate — all appeal levels
Overturns on specialty drug denials across Level 1 appeals through external review, once appeals cite the payer's own coverage criteria and the failed step-therapy record. Level 1 appeals alone run higher, at 84.2%.
Names and figures are illustrative composites drawn from early pilot use, shown to explain typical outcomes — not audited customer guarantees.
84.2%
Level 1 appeal win rate specifically
Based on early pilot data — full methodology to be published. Blended overturn rate across all appeal levels is 71%.
< 2 min
Time to generate a complete appeal package
12+ hrs
Coordinator time saved per provider weekly
$0
Implementation or EHR overhaul fees
Security & compliance
Built with compliance officers in the room, not bolted on afterwards.
Direct patient identifiers are stripped locally in the browser before anything is transmitted.
Strict BAAs guarantee clinical text is never retained or used to train third-party models.
AES-256 at rest and TLS 1.3 in transit across every request and stored dossier.
Every extraction, edit and export is logged for clinical governance and compliance review.
Signed HHS-standard BAA before your pilot begins — with expiration reminders, versioned revisions, guarded rollbacks and an exportable compliance ledger built in.
Pricing
Single-provider practice getting denials under control.
Billed monthly, cancel anytime
For 2–5 provider practices with a dedicated PA coordinator.
Billed monthly, cancel anytime
Multi-location clinic groups and management organizations.
Billed monthly, cancel anytime
FAQ
Run your first appeal dossier in the next ten minutes — no integration, no procurement cycle.
