Before deciding whether to engage Soft Appeals for recovery work, you receive an assessment of the denied claims reviewed. It identifies what happened, what may warrant action, what should be prioritized, and the recommended next step for each claim. The example below uses fictional claim information and exists only to show the format and the level of analysis. No patient identifiers appear in this public sample. An actual client assessment may contain protected information, and it is delivered through the approved secure process described on the Data and Security page.
The payer, denied amount, denial category, service information and available denial reason, organized into one review instead of scattered across remittances.
Known time-sensitive items and claims requiring prompt action are surfaced for priority review, so the queue has an order rather than a date stamp.
Each claim receives a recommended disposition: correct or resubmit, appeal, investigate, or close and deprioritize.
The assessment records the reasoning and the available information supporting each recommended action, so your billing team can check the logic rather than take it on trust.
Claims selected for recovery move into the appropriate Soft Appeals workflow, after your organization approves the scope.
Soft Appeals · a service of frimpomaasync.com
The whole deliverable a client receives, published in full. Every claim, payer, amount and date below is fictional. The method, the reasoning and the format are exactly what an actual review produces.
Page 01 · cover
Contents
Read the worklist first. Every claim in this review carries one recommended action, one owner and one next step. The rest of the document explains how each of those was decided.
Page 02 · contents
Section one
Appear to need correction or resubmission rather than a formal appeal.
Available information supports further review through an appeal pathway.
Additional documentation, payer clarification or an internal decision is needed first.
Information, timing or value may not support further recovery effort.
Priority attention: 3 claims · $4,150. These claims have known timing, documentation or recovery considerations that warrant priority review.
Priority is assigned using the Recovery Priority method set out below this assessment, not by claim age alone.
Initial observation. This review identifies a combination of correction opportunities, claims that may warrant formal appeal, items needing additional information, and claims where further recovery effort may not be appropriate. The purpose of the assessment is not to assume every denial should be appealed. It is to help determine where recovery effort should be directed first.
Denied amount is not the same as expected recovery. These figures represent the amounts associated with the reviewed denied claims and their recommended dispositions. They should not be read as guaranteed or projected reimbursement. Actual recovery depends on claim-specific facts, documentation, payer determinations, applicable requirements and other circumstances.
Page 03 · executive summary
Section two
| Priority | Claim | Payer | Denied | Category | Recommended action | Timing | Status |
|---|---|---|---|---|---|---|---|
| A | SA-001 | Sample Health Plan | $1,850 | Authorization | Investigate, then appeal | Confirm deadline | Action needed |
| A | SA-002 | Sample Health Plan | $1,425 | Medical necessity | Appeal | 18 days* | Ready for review |
| A | SA-003 | Example Insurance | $875 | Timely filing | Investigate | 24 days* | Evidence needed |
| B | SA-004 | Example Insurance | $640 | Claim information | Correct / resubmit | Confirm | Correction identified |
| C | SA-005 | Sample Health Plan | $525 | Documentation | Investigate | Confirm | Records needed |
| D | SA-006 | Example Insurance | $185 | Duplicate | Close, after verification | Not applicable | Low priority |
*Sample timing shown for demonstration only. Actual deadlines must be determined from the applicable payer, plan, claim circumstances and governing requirements. Six of the twenty reviewed claims are shown here. A real assessment lists every claim reviewed.
Page 04 · claim worklist
Section three
Page 05 · claim analysis
Section four
Individual denials can reveal operational patterns. Alongside the claim-level recommendations, the assessment records recurring themes visible within the reviewed sample.
Four of the twenty sample denials involve authorization-related issues.
Operational question: is authorization information consistently verified and retained before services are rendered?
Three claims need additional documentation before the appropriate recovery pathway can be completed.
Operational question: can supporting documentation be retrieved quickly when a payer requests it?
Five denials appear potentially addressable through correction rather than formal appeal.
Operational question: are recurring correction reasons tracked upstream, so the same issue shows up less often in future submissions?
These observations are directional and based only on the claims included in the review. A limited sample should not be treated as a complete revenue-cycle analysis.
Page 06 · patterns and actions
Section five
About this sample. This sample contains fictional information and exists solely to demonstrate the format of a Soft Appeals Denial Recovery Assessment.
Actual assessments are based on the information made available for the claims reviewed. Recommendations reflect the information available at the time of review and may change if additional claim, payer, plan, clinical, contractual, regulatory or other relevant information becomes available.
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.
This document is fictional. It exists to show the format and the depth of a real assessment. No patient identifiers appear anywhere in it, and no real client, payer or claim is described.
Page 07 · notes and limitations
Open this same portfolio as a live worklist →
The Recovery Lab is these same twenty claims, live: sort the worklist, filter it, open any claim and read why each recommendation was made.
Priority is assigned the same way on every assessment, using four factors anyone on your team can check. There is no proprietary success percentage attached to a claim, because a credible one would need enough of our own verified outcome data to stand behind, and that data is still being built.
How much reimbursement is at issue on this claim.
Whether known timing requires prompt action, or a deadline still needs confirming.
Whether there is an identifiable next step based on the information available now.
Whether enough is available to proceed, or additional documentation is required first.
Value, timing and an identifiable path all point the same way. These are worked first.
A clear next step, without the timing pressure that puts a claim in A.
The path may be viable, but something has to arrive before anyone can act on it.
The information, timing or value does not support spending more on the claim.
The same set of statuses is used on every engagement, so "where is SA-002" has one answer rather than a conversation. The two marked in copper are the points where the claim is with your team, not with us.
Soft Appeals works on denied-claim recovery. Recurring denial patterns may also point to something upstream that your organization could look at.
Recovery asks what the appropriate next step is for this denied claim. Prevention asks whether a recurring workflow issue is contributing to similar denials in the first place.
When a pattern shows up in the reviewed claims, we flag the observation for your team. What to do about the underlying process is your organization's decision, and your organization's call to make.
You decide which eligible claims, if any, you want Soft Appeals to pursue. For approved claims, the next phase may include these steps.
Confirm the appropriate reconsideration, appeal, resubmission or other available recovery pathway for the claim.
Identify and organize the available documentation relevant to the denial.
Prepare the appropriate appeal materials for client review.
Nothing is submitted in your organization's name until the agreed approval process is complete.
Record submission dates and the available delivery or acknowledgement evidence.
Track payer responses, requests for additional information, relevant deadlines and next actions.
When reimbursement is received, reconcile the outcome against the applicable remittance documentation.
The free review is the assessment. The recovery work is the execution, and it is the part with a fee attached, and that fee only exists once verified recovered reimbursement lands with you. The full process is on the offer page.
Start with 20 recent denied claims. Soft Appeals organizes the reviewed claims by recommended action, priority, financial value, known time sensitivity and next-step requirements. You receive the assessment whether or not you continue with recovery services. Free initial review, no obligation to continue.