Your Claimie guide.

Claimie is a claim denial recovery service. Your practice sends us the denial data your payers already produce; we read every denial code, work out which denials are worth fighting and by when, prepare the appeal paperwork, and pursue each one until the money is recovered or the case is honestly closed.

Two promises govern everything:

1. A person approves everything. No letter ever goes to a payer without a named person reviewing and signing off first.
2. Nothing is silently guessed. Unknown denial codes, unmatched files, and unverified deadlines are flagged and surfaced — never papered over.

Denial data — the fuel

• 835 / ERA files (preferred) — the electronic remittance files your clearinghouse or practice-management system already receives. Export them from your clearinghouse portal (Availity, Waystar, Office Ally — usually under “Remittance” or “ERA”) and upload the raw file; messy files are handled gracefully.
• CSV or Excel denial reports from your PM system (Athena, Tebra/Kareo, DrChrono, AdvancedMD, eClinicalWorks, and others). Standard exports are recognized automatically, and the portal’s Upload page has example templates showing exactly how the data should look.

Cadence: upload at least weekly. New 835s do double duty — they bring new denials in and automatically confirm which appealed claims got paid. Duplicate files are always safe; already-imported claims are skipped, never double-counted.

Documentation — when we ask

Winning appeals depends on documentation only your practice has: the EOB, prior-authorization confirmations, proof of timely filing, relevant chart notes (reviewed by your clinician), or corrected demographics. Upload documentation through the portal, not email — the portal is encrypted end to end. Appeal letters only ever reference documentation you actually provided; nothing clinical is ever fabricated.

1. Everything is read. Every claim, dollar amount, and denial code is extracted. Files that can’t be read are stored safely and flagged — nothing is lost.
2. Every denial is classified — correctable claim error, winnable appeal, medical-necessity review (always involves your clinician), or a true contractual write-off we won’t waste effort on.
3. Every recoverable denial gets a deadline from payer-specific rules, and the highest-value recoverable denials are worked first. Anything close to deadline is flagged urgent.
4. Appeals are prepared, reviewed by a person, and submitted — by fax with a stored delivery confirmation, through the payer’s portal with a confirmation number, or by tracked mail.
5. Your next uploads confirm the outcome automatically — paid, partially paid, or denied again (the next appeal level starts). A watchdog flags any appeal a payer sits on for 30+ days.

You can watch all of it live in the portal: Dashboard for totals, Queue for every workable denial with deadlines, Tasks for anything needing a decision, Files for everything uploaded.

AI (Anthropic’s Claude) helps draft appeal paperwork. Three hard limits:

• It cannot send anything. Every draft waits for a named person to review and approve it first.
• It cannot invent facts. Missing information becomes a clearly marked placeholder that blocks submission until resolved.
• It never sees patient identity. Names, account numbers, and dates are replaced with anonymous tokens before any text leaves for the AI service, and restored locally afterward.

One page, no ambiguity: dollars recovered, the service fee, your net gain, denials by category, your payers ranked by denied dollars, and the age of open items. The fee is a percentage of actually recovered dollars — if nothing is recovered, there is no fee.

• Encryption in transit: all access is HTTPS-only.
• Encryption at rest: every uploaded file and generated letter is encrypted on disk under keys we control.
• Audit trail: every login, upload, download, and view of patient data is permanently logged. The log cannot be edited.
• Least access: your practice’s users see only your practice’s data. Sessions time out after 30 minutes.
• AI privacy: patient identifiers are pseudonymized before any AI call — on by default.
• Backups: nightly, encrypted, with off-site copies.
• Termination: if our agreement ends, your data can be exported to you and hard-deleted per the BAA.

What we ask of your staff: never email PHI (upload through the portal instead); never share logins; tell us the same day a staff member with access leaves your practice so their account can be deactivated immediately.

Will the AI ever send something to a payer on its own?

No. Submission requires a recorded human sign-off first — it is architecturally impossible for anything to go out without one.

What file types can we upload?

Raw 835/ERA files (.835, .era, .edi, .txt, .x12), CSV denial reports (.csv, .tsv), and Excel workbooks (.xlsx). Max 50 MB per file. Example templates are on the portal's Upload page.

How fast is processing?

Parsing and triage are immediate — you see the results on the upload screen within seconds.

What if we upload the same file twice?

Nothing bad. Already-imported claims are detected and skipped; re-uploads are how payment confirmations arrive, so it's encouraged.

What happens if the payer denies the appeal?

Your next 835 detects it automatically and the next appeal level begins — payer rules track how many levels each payer offers.

Who do we contact with questions?

Your Claimie contact (provided at onboarding). For anything involving patient information, use the portal — not email.

835 / ERA

Electronic Remittance Advice — the payer's electronic explanation of what was paid, denied, and why

CARC

Claim Adjustment Reason Code — the payer's reason for denying/adjusting (e.g., 197 = no prior authorization)

RARC

Remittance Advice Remark Code — supplementary detail on a CARC

ICN

Internal Control Number — the payer's own tracking number for a claim; used on every appeal

EOB

Explanation of Benefits — the human-readable version of a remittance

Prior authorization

Payer approval required before a service; missing auth (CARC 197) is a top denial reason

Timely filing

The payer's deadline for the original claim; distinct from the appeal deadline

Contractual adjustment (CO-45)

The normal write-off between billed charge and contracted rate — not recoverable, not a denial

Corrected claim

A resubmission that fixes an error, as opposed to a formal appeal

Recovery

Dollars actually paid by the payer on a claim Claimie worked