Sample Every claim, payer, amount and date in this Lab is fictional. No patient information appears here and none is requested.
Twenty denials · every recommendation explained
The Recovery Lab
Denied value by recommended action
Denied amount is not the same as expected recovery. These figures are the amounts attached to the reviewed claims and their recommended dispositions, not projected reimbursement. No recovery projection appears anywhere in the Lab.
Where the next action sits
Two statuses put a claim with your team: Additional information needed and Client review. Everything else is owned by Soft Appeals or sits with the payer. That split is the point: at any moment, each claim has exactly one owner and one next action.
Denied value by payer
Denials by category
Payer names in the Lab are fictional. In a real assessment this section names your actual payers, and the category mix comes from your own denials.
| Payer | Category | Recommended action | Status | Owner | Next action |
|---|
Select any claim to open the full record, including the reasoning behind its recommendation. Timing marked with * is sample timing for demonstration only. Actual deadlines must be determined from the applicable payer, plan, claim circumstances and governing requirements.
Recurring themes in this portfolio
Pattern observations are directional and describe only the claims in the reviewed sample. A limited sample should not be treated as a complete revenue-cycle analysis. In a real engagement, these observations become upstream questions for your team, because a denial category that keeps recurring is usually cheaper to prevent than to recover.
About this Lab. Everything above is fictional and exists to demonstrate how Soft Appeals reviews, prioritizes, tracks and resolves denied claims. The claims, payers, amounts, statuses and timing are invented, and they match the published sample assessment so the numbers you see here and there are the same numbers.
A recommendation to pursue a claim does not guarantee reimbursement or reversal of a payer determination. Soft Appeals does not independently make clinical, coding, legal or coverage determinations outside the agreed scope of service. Soft Appeals is a service of frimpomaasync.com.
Reasons you can check, not a number you have to trust.
Every recommendation in the Lab is explained by the same kind of factors: what the denial states, what the available documentation shows, which pathways were considered, and what is still missing. That is what Show me why opens on every claim.
What you will not find is a percentage next to any claim. A probability score would be a prediction dressed up as data, and it would tell you nothing about what to do next. The factors tell you exactly what to do next, and they can be checked against your own records.
Now run the same method on real denials.
The free review applies exactly this process to 20 of your recent denied claims. Business-level intake first, no patient information through the website, and the assessment is yours whether or not you continue.