Soft Appeals examines what happened, identifies the appropriate next action, gives the work an owner and tracks it through reconciliation.
Fictional demonstration · no patient data · no outcome promised
Sources: Maryland Office of the Attorney General, Health Education & Advocacy Unit, FY2025 report · Office of the Governor, 7 August 2026. These are Maryland state figures, not national estimates.
I am not a billing company and I am not trying to become one. Your team keeps the revenue cycle. I take the pile that keeps getting pushed to tomorrow. Anything that turns out to be a correction rather than an appeal goes straight back to them, with a note explaining why.
Five or more clinicians. Mental health adverse decisions in Maryland rose 149.5% in a single year, the fastest-growing category in the state.
APTA Maryland's own figures: 13.08% of filed claims denied, 66.14% of those appealed, 52.34% overturned. Nearly half of the appeals that were filed still failed.
The largest non-pharmacy denial category in Maryland: 16,256 adverse decisions and 16.8% of all grievances. Dental engagements are priced on a fixed fee, not a percentage. Here's why.
A solo clinician billing fifteen sessions a week does not have a denial problem worth outsourcing, and I will tell you so on the first call. The free review costs you nothing either way.
Through 2025 the ASO's claim inventory peaked at 437,102 in March, and claims aged past thirty days peaked at 138,081 in April. If you billed the public behavioral health system last year, you were almost certainly paid late on a meaningful number of claims.
Maryland's prompt payment law reaches the behavioral health ASO. It sits in Health-General § 15-103(b)(21)(vi), not in the Insurance Article and not in any provider manual, which is why almost nobody knows it is there. It requires interest at 1.5% per month on days 31 to 60, 2% on days 61 to 120, and 2.5% after that. And § 15-1005(g)(2) says that interest is supposed to be included in the payment without the provider ever asking for it.
So the only real question is whether it was. Most practices have never checked, because nobody told them there was anything to check. I will check it for free. If you were paid correctly, I will tell you that and we are done.
Source: Maryland Senate Finance Committee briefing, "Carelon and Medicaid Update," 29 January 2026.
Nothing is submitted in your organization's name without written authorization. Payers reimburse you directly. Funds never pass through me, which is deliberate and is written into the engagement letter.
Business associate agreement executed before any protected health information moves. The free review needs none.
Sorted by deadline remaining, not by dollar amount. Sorting by dollars is how recoverable claims quietly expire.
Answering the denial reason that was actually written, with the specific document that addresses it.
Filing evidence retained. Deadlines counted in working days where the statute counts them that way.
What came back, matched against what was owed, including statutory interest where it applies.
Of verified recovered reimbursement attributable to the engagement, and only after the money arrives and is verified. Not on submission. Not on a favorable letter. Nothing recovered means no fee.
A monthly retainer or a fixed per-appeal fee rather than a percentage. Maryland's dental practice statute requires that compensation to an unlicensed person be a predetermined fixed amount, so a contingency arrangement is the wrong structure here.
Md. Health Occ. § 4-103(e)(14)Government program claims are priced separately and agreed before any work starts. Federal rules restrict percentage-based compensation for this work, so it is quoted flat or hourly.
42 CFR 447.10(f) · 42 CFR 424.73(b)(3)Whichever applies, the review of your first twenty denials is free, and the engagement letter states the structure in writing before anything begins.
One honest caveat, because most advice on this gets it wrong: a large majority of Maryland dental plans are self-funded and therefore outside the Insurance Administration's jurisdiction. For most dental claims, "file a complaint with the MIA" is not the answer. Your contract terms and your documentation are.
No named client result yet, and I will not invent one.
I could put anonymous quotes here. A therapy practice in the Midwest recovered forty thousand dollars. Nobody could check it and nobody would ask.
Here is why I haven't. This is a business about whether payers can be held to what they actually owe. If I am loose with my own numbers on my own website, you have no reason to trust my reading of your remittance. So what is here instead is a method you can inspect, a sandbox you can open, and a standard I published with the weights included. When there is a real result and a client willing to go on record, it goes up with their name on it.
You will get them back organized by recommended action, value, priority and time sensitivity, plus an honest note about which ones are already gone and why. The review runs on a five-column sheet with no patient information: payer, procedure code, denial reason code, billed amount, age. Fill twenty rows, email it back. There is no upload field on this form by design.
I'll come back to you within one business day with the five-column sheet, no patient information on it, and what goes in each column. Nothing is submitted anywhere on your behalf until you authorize it in writing.
A copy of what you just sent is on its way to your inbox, so you have a record of it without waiting for me.
In the meantime, the denial code decoder is free and runs entirely in your browser.
It should be, and often they do it well. The issue is usually queue position rather than skill. New claims, payment posting, corrections and patient calls all arrive ahead of denials, every single day, and a denial that arrives last on Monday arrives last again on Tuesday. I am not replacing your biller. I take the pile that keeps getting pushed to tomorrow, and anything that turns out to be a correction rather than an appeal goes straight back to them.
No. Maryland practices only, and that is a deliberate choice rather than a limitation. The rules I work with are Maryland rules: the statutory 180-day filing floor, grievance clocks counted in working days, the four-month window to the Insurance Commissioner, the Maryland Insurance Administration's provider complaint route. Roughly 78% of Maryland's small-group market sits with a single carrier, which means I know one payer's behavior extremely well rather than fifty payers' behavior vaguely.
Twenty-five percent of what is actually recovered on eligible commercial claims, and only after the money arrives and is verified. Not on submission, not on a favorable letter. If nothing is recovered there is no fee. Dental practices are priced on a fixed fee instead, because Maryland's dental practice statute requires fixed compensation for this kind of work. Medicare, Medicaid and HealthChoice claims are scoped and priced separately before anything starts. The review of your first twenty denials is free in every case.
Not yet, and I will not invent one. Nobody has finished an engagement and gone on record. What I can show you is the method, a sandbox with twenty fully worked fictional claims, and a published standard with the weights included. Judge those instead. When there is a real result and a client willing to be named, it goes up with their name attached.
The free review runs on a five-column sheet: payer, procedure code, denial reason code, billed amount, and how old the denial is. No names, no dates, no member numbers, so nothing needs signing before it. If you continue into recovery work, a business associate agreement and a secure intake channel come first, before any patient information moves. Nothing is ever submitted in your organization's name without written authorization, and payers reimburse you directly. Funds never pass through me.
I work with practices rather than individuals, so I cannot take on a personal claim, but two things will help. The denial code decoder on this site explains what the codes on your explanation of benefits actually mean, free and with no signup. And Maryland's Attorney General runs a Health Education and Advocacy Unit that helps consumers with denied claims at no cost, on 877-261-8807. They are genuinely good at it.
Deeper questions about scope, PHI, security, approval, tracking, timing and pricing are answered on the full questions page, written so you can send it to a biller, an administrator or a compliance reviewer.
No patient information, no obligation, and an honest answer about whether the work makes sense for you. If it doesn't, I will say so on the first call.