Pricing
Two models. One rule: the math has to be a no-brainer for you.
Most clients choose performance pricing: we're paid a percentage of what we actually recover, and nothing if we recover nothing. Some states restrict percentage-based fees for claims services, and some practices simply prefer a fixed line item. So we built both.
Model A
Performance Recovery
CONTINGENCY
You pay: a % of dollars actually recovered. Nothing recovered = nothing owed.
Tiered by claim age at engagement
- Starts with the free Recovery Audit ($500 value), with a written go/no-go before any commitment
- No setup fee, no monthly minimum, no long-term lock-in (90-day initial term, then month-to-month)
- Best for: practices that want zero risk and perfectly aligned incentives
Availability: most states (see fine print, clause 4)
Model B
Flat-Rate Recovery Program
FIXED MONTHLY
You pay: a fixed monthly rate based on claim volume and open AR size. Every recovered dollar is 100% yours.
Tiers
- Same team, same AI pipeline, same reporting as Model A
- Starts with the free Recovery Audit ($500 value), with a written go/no-go before any commitment
- 90-day initial term, then month-to-month; 30-day notice
- Best for: practices in restricted states, larger groups that model the math, and billing-company partners
Availability: all 50 states
The No-Brainer Frame
Under Model A, we only eat what we kill. Under Model B, you keep every recovered dollar and pay a flat rate that’s typically a fraction of one recovered high-value claim; the average denied Medicare Advantage claim alone is now about $1,000.1
Do the math on your own practice. If you submit 1,000 claims a month at an average of $150, and 11.8% are denied, that's $17,700 of earned revenue stalled every month. Industry data says up to two-thirds of it is recoverable, but 50–65% of denials are never even worked, because it costs $25–$100+ in staff time to fight each one. That's not a billing problem. That's a profit leak.
The math works. Want us to run yours?
15 minutes, a real person, no pitch deck. Or skip the call and sign up online. Prefer to dial? (479) 274-0716
THE SMALL PRINT: Why we charge what we charge, and the terms that keep it honest.
1. Why contingency percentages scale with claim age. Recovering a 30-day-old eligibility denial and resurrecting a 14-month-old, twice-denied claim are different jobs. Industry data puts the cost of reworking a single denial at $25 to over $100 in labor,ᵃ and older claims require appeal research, medical-records assembly, payer escalation, and often multiple appeal levels under shrinking timely-filing and appeal deadlines. Our tiers reflect actual cost and risk: we take 100% of the risk of non-recovery, we advance 100% of the labor, and we are paid only from results. That is why aged AR carries a higher percentage, and why most firms simply refuse to touch it.
2. “Recovered” is defined narrowly, in your favor. A dollar counts as recovered only when a payer payment or approved adjustment attributable to our work posts to your accounts. Payments already in flight before engagement, patient payments, and capitation or incentive payments are excluded. You receive a line-item recovery report with every invoice; you pay only on what you can verify against your own remits.
3. We never touch your money. All payer payments flow directly to you exactly as they do today. Claimie has no lockbox, no trust account, and no authority to negotiate settlements below contract rates without your written approval. We are a recovery and appeals service, not a collection agency, and we do not pursue patients.
4. State availability of percentage-based pricing. A number of states restrict or prohibit percentage-based (“contingency”) fee arrangements for medical billing and claims services under state fee-splitting, corporate-practice-of-medicine, or professional-fee statutes; New York is the most cited example. In any state where our counsel determines percentage-based pricing is restricted for your provider type, Model A is unavailable and we offer Model B (Flat-Rate) exclusively. The current state-availability map is published at claimie.ai/compare#availability (as of July 2026: flat-rate only in New York and Nevada; percentage available with statutory conditions in California, Florida, and Illinois; both models elsewhere) and is confirmed for your specific situation during the Recovery Audit. Nothing on this page is legal advice; final pricing model and terms are set in your services agreement after state-specific compliance review.
5. Why the flat rate is priced where it is. Each tier is priced below the blended in-house cost of the work it replaces: at the industry-average rework cost of $25 per denied claim,ᵃ a practice with 1,500 monthly claims and a typical 11.8% denial rateᵇ generates roughly 177 denials a month: over $4,400/month in rework labor alone, before appeals, before software, before turnover, and before the 50–65% of denials that never get worked at all.ᶜ
6. No recovery theater. We do not resubmit claims blindly to inflate activity metrics, we do not appeal claims with no reasonable basis, and we do not sign engagements the audit doesn’t justify. Roughly two-thirds of denials are recoverableᵈ; our job is to find your two-thirds and tell you the truth about the rest.
7. Taxes, term, and exit. Fees exclude applicable taxes. Initial term 90 days, then month-to-month with 30-day written notice. On exit, you keep all reports, appeal files, and documentation; your data is yours.
ᵃ MGMA/HFMA industry reports · ᵇ 2024 industry claims data · ᶜ MGMA · ᵈ Advisory Board
Know your number before you sign anything.
The Recovery Audit is a $500 analysis, yours free, in writing, with an honest go/no-go. Limited slots each month.
Sources
- 1.The average denied Medicare Advantage claim is now worth about $1,000, up 22.4% year over year. MDaudit network data, 2025
- a.The average cost to rework a single denied claim is $25, and can run over $100 per appeal; some estimates range up to $118–$181. MGMA / HFMA / Change Healthcare industry reports
- b.Initial claim denial rates hit 11.8% in 2024, up from ~10.2% a few years earlier. Industry claims data, 2024
- c.50–65% of denied claims are NEVER reworked or resubmitted. MGMA
- d.Roughly two-thirds of denied claims are recoverable. Advisory Board