Your billers already won this money.
11.8% of claims get denied. 60% of those denials are never appealed, even though 70-80% of appeals win when filed. NxtPivot is the AI layer that closes the gap.
PDF parsed into a structured claim
837P, CPT 99214 + 90837
Denial classified and ranked
CARC 197, recoverable, ranked #1
Appeal letter drafting
Citing Aetna policy §31.04…
Recovered value
$1,284.50
Time to appeal
3.2s
The math of revenue leakage
11.8%
of claims denied industry-wide
2024 industry average, up from 10.2%
60%
of denials are never appealed
The single biggest source of leakage
70-80%
of appeals win when actually filed
The money is yours, you just stopped asking
64%
of denials are preventable (MGMA)
A scrubber agent would have caught them
The agents
An AI workforce, named, specialized, and easy to talk to.
NxtPivot is not one model with one prompt. It is eight agents, each with one job. Ask Pivot is the chat surface that orchestrates the others, remembers every claim, and pulls any report you ask for in plain English.
Meet the full cast →Why now
Your EHR is a system of record. It was never going to be the AI layer.
Greenway, eCW, Athena, Kareo. They are filing cabinets with billing modules bolted on. The denial work, the appeals, the eligibility hunts, that is still you in a spreadsheet at 6pm. NxtPivot is the layer that does that work, on top of whatever EHR you are stuck with.
Read the full story →- Denials land in a worklist sorted by date, not by recoverability.
- Appeals are written from scratch in Word, copy-pasted into the payer portal.
- Eligibility lookups are 15 minutes per patient on a state portal that times out.
- Payer policy text lives in PDFs nobody reads before the appeal deadline.
- The biller who knew the patterns left. The patterns left with them.
- Denim ranks denials by expected recovery, the highest-yield claim is the next one your team touches.
- Amber drafts appeal letters from Plum's policy citation. Already attached.
- Found Money runs eligibility lookups in seconds, queues the rebill, no portal time.
- Every agent action is logged per claim, compliance sees the same trail the biller does.
- Pivot remembers. Patterns the agents learn on one claim prevent the next.
Use cases
Four workflows where the agents pay for themselves.
Found Money
Find the money you didn't know was already yours.
Coverage finder for your self-pay book. Retro-Medicaid, secondary, workers' comp.
Read →CARC 197
Reduce missing-auth denials by 50-65%.
Pearl scrubs at submission. Denim ranks the rest. Amber wins back the recoverable ones.
Read →Aged AR
Triage aged AR by expected recovery, not by date.
3-5x more revenue per biller-hour. Same team, ranked queue.
Read →Behavioral health
Specialty-trained scrubbing for psych and therapy claims.
16-20% denial rates cut to industry-average with the right pre-submission checks.
Read →Compliance
HIPAA-compliant, cloud-based, audited per claim.
PHI never leaves the HIPAA-eligible boundary. Every model call is BAA-backed. Every agent action is logged. Your compliance officer reads the same trail your biller does.
Read the full posture →Free leak assessment
Sign a BAA. Send a report. Get a sized leak assessment.
Free of charge. No PHI moves until paperwork is signed. We return denial gap, eligibility gap, and AR-priority leak, all sized in dollars for your book.
Request the assessmentFrom the blog
Playbooks for getting the leak under control.
Denial recovery
Why 60% of denials are never appealed (even though 70-80% of appeals win)
The math, the friction, and the playbook for closing the largest revenue gap in outpatient billing.
Read →Found Money
Post-approval Medicaid retro-eligibility: the cash cow billers still do by hand
How to automate the highest-leverage workflow in your operation.
Read →CARC playbook
CARC 197 decoded: how to win back missing-authorization denials
The most common denial code in outpatient billing, the appeal template that wins.
Read →Run it on your own data
Bring one denied claim. We will bring back the appeal.
15 minutes on your own data, under BAA. No contract, no NDA gymnastics. You see what the agents produce, then you decide if a pilot is worth a conversation.
$92K
Per-clinic recoverable revenue, per year.
$2.3M
Same math, scaled to a 25-clinic book.
3.2s
Average time from denial to drafted appeal.
0 PHI
In the demo. Redaction first, conversation after.