Three Leaks. One Execution Layer. Closed 24/7
11.8% of claims denied. 3–7% underpaid. Claims past 120 days nearly uncollectible. ANKA closes all three leaks—automatically.
ANKA sits downstream of your billing system, operating on claims already submitted to payers. From EOB receipt to aging AR to underpayment discovery—everything is worked 24/7. Your team handles claim submission, coding, and billing. ANKA handles everything after that: identifying appealable denials, recovering underpayments, resolving aged AR, and executing follow-up. EHR-agnostic. No rip-and-replace. No 6-month implementation.
Without ANKA vs. With ANKA
Here's what happens to a denied claim in the real world.
| Step | Without ANKA | With ANKA |
|---|---|---|
| 1. EOB Received | Payer sends EOB. It sits in inbox or EHR until someone has time to read it. | EOB lands. AI reads it in seconds. Extracts denial reason, claim details, payer rules. |
| 2. Gather Clinical Documentation | Your billing staff spends 30–45 minutes finding the right clinical note, imaging report, or auth form. | AI pulls clinical history automatically from your EHR. Cross-checks against payer requirements. Zero manual digging. |
| 3. Write the Appeal | Someone writes appeal language. References clinical docs. Checks payer policy. 1.5–3 hours per appeal. | AI generates appeal letter. Cites the exact clinical evidence. Matches payer appeal guidelines. Ready to send. |
| 4. Route for Review | Appeal sits in someone's inbox. Review depends on workload. Delays = missed timely filing deadlines. | Your team reviews the 10% that need human judgment (unusual cases, missing docs). The other 90%? Submitted automatically. |
| 5. Submit to Payer | Someone manually submits appeal. Tracks submission date. Adds to spreadsheet. Sometimes forgets. | Appeal submitted via payer portal or mail. Submission logged automatically. No lost track. |
| 6. Track Outcome | Status check requires calling payer. 15–30 minutes on hold. Getting transferred. No answer. | AI monitors appeal status automatically. When payer responds, AI flags it. Your team sees the outcome in real time. |
| 7. Close or Rework | Appeal gets paid or denied. If denied again, claim goes to aged AR. Often written off as uncollectible. | Paid = closed. Denied again = AI reworks with new approach. Tracks through maximum appeal levels. Nothing abandoned. |
The difference isn't in the process. It's in the execution. ANKA doesn't inform. It does the work.
Six Powers That Close the Revenue Execution Gap
Unified AR queue: every claim from every system, ranked by recovery priority, with one-click actions.
Glass-Pane Interface
Unified AR view across EHRs, billing systems, clearinghouses, and payer portals. Single dashboard. No context switching. See all claims, denials, appeals, and follow-ups in one place.
AI-Driven Claim Prioritization
Machine learning ranks claims by recovery probability, dollar value, aging, and payer behavior. Work the highest-value claims first. Don't waste time on denials that won't overturn.
Orchestration Layer
Next best action decision engine. For each claim: Should we appeal? Rework? Request additional docs? Follow up with the payer? The system decides. You execute or override.
Autonomous Resolution with Human Loop
AI auto-executes repeatable AR actions. Routes complex cases to humans. Voice AI handles phone follow-ups with payers. Your team stays in the loop on every decision.
Self-Learning Orchestration
System learns from outcomes over time. Which appeals work? Which payers overturn denials? Which follow-up strategies succeed? Routing and prioritization improve automatically.
Three-Leak Revenue Intelligence
Maps all three revenue leaks in real time: denied claims (Leak 1), underpaid claims (Leak 2), and aging AR (Leak 3). Prescriptive insights for your CFO: where the money is leaking, why, and how to close it.
What an AI-Generated Appeal Actually Looks Like
Not a template. Not a framework. An actual appeal letter, generated in seconds, ready to submit.
ANESTHESIA ASSOCIATES OF NASHVILLE
PO Box 1234, Nashville TN 37201
Invoice #: ANS-2025-047821
Date: February 10, 2025
Claim Number: CLM-5847291
Service Date: January 15, 2025
Patient Name: J. Thompson
Patient ID: 487291-B
RE: APPEAL OF CLAIM DENIAL – Medical Necessity
Dear BCBS Health Select Appeals Team,
We respectfully appeal the denial of the above-referenced claim dated January 15, 2025. The claim was denied on the basis of "medical necessity not established." We provide clinical evidence supporting the medical necessity of the anesthesia services rendered.
CLINICAL JUSTIFICATION:
The patient underwent a left rotator cuff repair, a major surgical procedure. Per ASA guidelines and standard anesthesia protocol, general anesthesia with endotracheal intubation is the standard of care for this surgical intervention. The operative report documents a surgical time of 87 minutes—well within the parameters requiring general anesthesia for patient safety and surgical accessibility.
Per your medical policy guidelines (Policy #MA-2025-008, Section 4.2), general anesthesia is medically necessary when: (1) the procedure exceeds 45 minutes, and (2) the surgical complexity requires airway protection. Both criteria are met in this case.
SUPPORTING DOCUMENTATION:
- Operative Report (January 15, 2025) – Surgical time: 87 minutes
- Anesthesia Record – ASA Class II; general anesthesia with endotracheal intubation
- Your Medical Policy #MA-2025-008 supporting this determination
Based on the clinical documentation and your own medical necessity guidelines, this claim should be reimbursed at the contracted rate of $487.00.
We request immediate review and payment of this appeal. Please contact us if additional information is required.
Sincerely,
Anesthesia Associates of Nashville
Appeals Team
Phone: (615) 555-0147
Email: appeals@aanashville.com
This is a real example generated by ANKA. Names and dates changed for privacy. Clinical reasoning and evidence structure exactly as submitted to payers.
AI handles the 90%. Your team handles the 10% that matters
Human judgment where it's needed. Automation everywhere else.
What ANKA Does
- Reads EOBs and denial reasons
- Pulls clinical documentation
- Writes appeal letters
- Submits to payers
- Tracks appeal status
- Escalates follow-ups
- Recovers underpayments
- Routes to your team only when needed
What Your Team Does
- Review unusual appeals
- Handle missing documentation
- Make judgment calls on edge cases
- Manage high-value disputes
- Communicate with payers on complex issues
- Provide outcome-level oversight
- Focus on strategy, not tasks
- Do the human work that matters
Your billing staff go from processing denials to managing outcomes. They shift from 8 hours of drudgery to 2 hours of actual decision-making. Turnover drops. Satisfaction rises. Revenue doesn't leak.
From contract to live execution. 4 weeks
Most healthcare IT implementations take 6–12 months. ANKA is different.
Week 1–2: Connect
We integrate with your EHR (Epic, Cerner, athenahealth, others). Establish secure data pipeline. Map your claim structure. Zero patient data exposure until you approve.
Week 3–4: Configure
Your team defines appeal thresholds, payer-specific rules, clinical pathways. We train your billing staff on the dashboard. Run dry-run appeals. You see output before anything goes live.
Week 4: Go Live
Go live with full denial volume. Your team monitors, flags exceptions, reviews outcomes. Appeal acceptance and collection data flows in real time. We iterate based on your feedback.
Week 4+: Optimize
AR recovery kicks in. Underpayment monitoring goes active across all payers. Continuous optimization based on outcomes. Your revenue cycle works 24/7.
Traditional Enterprise RCM Vendor
6–12 months
Implementation. Integration. Testing. Training. Deployment. Then months of optimization.
ANKA
4 weeks
Connect. Configure. Execute. Live. While your team learns to trust the output.
Why speed is possible
ANKA doesn't replace your EHR. It doesn't demand data migration. It doesn't need new infrastructure.
Post-Claim Positioning
ANKA integrates downstream of billing. Your team controls submission, coding, and billing decisions. ANKA works everything after claim submission: denials, underpayments, follow-ups, aged AR.
Security First
SOC 2 Type II certified. HIPAA BAA before any data transfer. Patient data encrypted in transit and at rest. US-stored. Audit logs for every transaction.
Plug-and-Play Payer Integration
We've already mapped payer requirements for 100+ payers. Appeal formats. Documentation rules. Timely filing deadlines. When a new payer rule changes, we update it. You don't.
Real-Time Execution
Denials are worked in hours, not days. Appeals submitted immediately. No queues. No bottlenecks. You see the work happening in real time on your dashboard.
Start Your Complimentary Assessment
We'll analyze 100–500 of your denied claims, underpaid claims, and aged AR. Show you exactly what ANKA would recover. Prove the timeline works for your organization. Real data. Real numbers.
Complimentary for qualified organizations (10+ providers).
Calculate Your ROI5–10 business days. Complete revenue cycle analysis.