Denials compete with everything else.
New claims, payment posting, corrections, authorizations and patient questions all arrive first. Some denials get resolved. Others stay in the queue until the opportunity to act is smaller than it was.
Soft Appeals · denied-claim revenue recovery
Recover revenue already earned.
Soft Appeals helps healthcare organizations find the denied claims that still have a viable recovery path, then works them. We review recent denials, decide which ones warrant action, prepare evidence-supported appeals, track deadlines and submissions, and reconcile what comes back. Your billing team keeps the revenue cycle. We take the denied claims you assign us. Start with a complimentary review of 20 recent denials.
BAA before PHI
No EHR access required for the initial review
Client approval before submission
Recovered payments go directly to your organization
19%
of in-network claims were denied by HealthCare.gov marketplace insurers in 2024
Under 1%
of those denials were appealed: 262,982 appeals against roughly 85 million denied in-network claims
54%
of initially denied private-payer claims were overturned and paid, after more than one round of appeals
$0
for the initial review of 20 denials. No paid recovery commitment, no monthly minimum
Denial and appeal figures: KFF, claims denials and appeals in ACA marketplace plans in 2024. Overturn figure: a Premier survey of leaders at 516 hospitals across 36 states, reporting on 2022 claims. Those are hospital and marketplace numbers, not a forecast for your organization. Your own denial data is the only thing that answers the question for you.
Denials are only half of it. The other half is capacity.
Every denied claim adds a decision to the billing team's day: correct it, appeal it, escalate it, follow up, or write it off. When higher-priority billing work takes precedence, recoverable denials sit unresolved until the filing or appeal window narrows. Soft Appeals gives that unresolved revenue a workflow of its own.
Denied claims get a defined recovery path.
We evaluate the denials you assign, organize them by recommended action and urgency, prepare the appropriate appeal documentation, track submissions, and maintain the recovery record.
Keeps the revenue cycle.
Submission, coding, posting and routine corrections stay where they are. We work the denied claims assigned to us and coordinate with your team when a claim needs something only they can provide.
Complimentary denial review
Before you commit, see what may be recoverable.
Start with 20 recent denied claims. We review them and return a short recovery assessment covering five things.
01
Recommended action
Correct, appeal, investigate further, or close.
02
Priority
Which claims deserve attention first, and why they rank where they do.
03
Financial value
The denied amount associated with each reviewed claim, in dollars.
04
Time sensitivity
Known appeal or resubmission deadlines that need attention before they narrow.
05
Reasoning
Why each claim received the next step it did, written so your billing team can check the logic.
There is no charge for the initial review. The report belongs to your organization whether or not you continue with Soft Appeals.
A clear process from denial to resolution.
Five steps. You send the denials once, approve what goes out in your name, and see the record at every stage. The full seventeen-step workflow is on its own page, including who owns which action and what happens when a claim stalls.
01
Secure intake
Before protected health information is exchanged, the applicable Business Associate Agreement is executed. Your organization then provides the agreed denial documentation through the designated secure process. Routine access to your EHR is not required for the initial denial review.
02
Review and prioritization
Each denial is evaluated on the information available: denial reason, documentation, applicable payer requirements, financial value, and relevant submission or appeal timelines. Claims are then organized by recommended next action and urgency.
03
Appeal preparation
For claims selected for appeal, we research the applicable payer requirements and prepare the appeal package from the available claim documentation and supporting evidence. Each appeal is reviewed before it is presented to your organization for approval. Nothing is submitted in your organization's name without authorization.
04
Submission and tracking
Approved appeals are submitted through the appropriate channel with supporting documentation. Submission dates, available proof of delivery, payer responses, follow-up activity and relevant deadlines are documented, so the status of every assigned claim stays visible to you.
05
Recovery reconciliation
Any recovered reimbursement is paid directly by the payer through your organization's normal payment process. Soft Appeals does not receive or hold payer funds. Recovery activity is reconciled against the applicable remittance documentation so the financial outcome can be verified on your side.
See the deliverable
Know what deserves attention before spending time on it.
The denial review sorts the selected claims into categories your billing team can act on directly.
The review · one page
Five categories, every claim in one of them.
Four of them describe what to do next. Some claims need a correction or a resubmission rather than a formal appeal. Some have enough behind them to support an appeal. Some need additional documentation, payer clarification or an internal decision before anyone can say which. And some are better closed, because the timing, the value or the information available does not support spending more on them.
The fifth category cuts across the other four. Claims with a known deadline approaching are surfaced separately, so the ones running out of time get looked at first.
Appeal pathways
Some denials need more than one level of review.
The pathway available varies by payer, plan, claim type, jurisdiction and denial reason. Depending on the circumstances, the options may include an initial reconsideration or appeal, an additional internal review, and external or independent review where it applies. Soft Appeals identifies the pathway available for each assigned claim and tracks the requirements and timelines that come with it.
Not every claim qualifies for every level of review. Escalation is decided claim by claim, on what that claim can actually support.
Pricing
Recovery-aligned pricing.
For eligible commercial claims accepted for recovery, the Soft Appeals fee is 25% of verified recovered reimbursement attributable to the recovery engagement. The payer continues paying your organization directly. After recovery is verified against the applicable remittance documentation, we invoice the agreed fee.
You keep 75 cents of every dollar.
The invoice arrives after the payer has paid you, and it references the remittance documentation used to calculate the fee, so your team can check every line against its own records.
No contingency fee is due for that claim.
Nothing for the initial review, nothing for the appeal work, nothing for the follow-up. There is no monthly retainer and no minimum, so you are not paying for a denial-management subscription between recoveries.
Scoped and priced separately.
Government-program claims may be subject to different legal, contractual or fee requirements. Where they apply, pricing and scope are agreed separately before any work begins on those claims.
Individual claims from $150. Smaller claims are worked in batches where the payer's process allows one submission to cover several claims. The full pricing and engagement terms are on their own page, including what counts as a verified recovery and what is excluded from it.
Who we support
Extra denial-recovery capacity, without another internal workflow.
Soft Appeals works with healthcare organizations that have denied claims needing attention and limited internal capacity to pursue every viable recovery opportunity. That includes organizations such as:
Behavioral health and therapy practices
Physical and occupational therapy organizations
Dental practices and groups
Chiropractic and podiatry organizations
Primary and specialty care organizations
Multi-provider groups
Other provider organizations with unresolved claim denials
Fit is determined by claim type, payer mix, denial volume, the documentation available, and the scope of the recovery work requested. Substance use disorder claims are out of scope. The records behind them carry their own federal requirements, and the right thing to do is leave those claims where they are.
Privacy and process
Built to ask for less access, not more.
Denied-claim recovery can involve protected health information. That responsibility is part of the service rather than a footnote at the end of it.
01
Business Associate Agreement first
The applicable BAA is executed before any PHI is exchanged for the engagement.
02
Minimum necessary information
We request the information reasonably needed to evaluate and work the assigned claim, rather than asking for broad access by default.
03
No routine EHR access for the initial review
The complimentary denial review starts from denial documentation you provide securely. Nobody needs a login to your systems to complete it.
04
Controlled submission
Nothing is submitted to a payer in your organization's name without the agreed authorization and approval process.
05
Direct payer reimbursement
Payers keep paying your organization through the normal reimbursement process. Soft Appeals never takes custody of payer funds.
06
Documented activity
Assigned claims are tracked through review, appeal activity, payer response and resolution, and that record is available to you.
About Soft Appeals
Healthcare operations experience behind the process.
Soft Appeals was founded by Nana Frimpongmaa, MHA, whose professional experience spans healthcare operations, performance improvement, administrative workflow, and health-system technology implementation.
That background shapes how Soft Appeals treats denial recovery: as an operational process that needs documentation, clear ownership, deadline management, appropriate escalation, and outcomes somebody can measure afterwards.
Soft Appeals is a service of frimpomaasync.com, and it is built to complement an existing billing operation by adding focused capacity for the denied claims selected for recovery.
Denial recovery checklist
Five controls worth checking in your denial workflow.
You do not need to become a Soft Appeals client to use these. They are the same categories of control we look at when reviewing assigned denials.
01
Preserve submission evidence
Find out how long your clearinghouse and other submission systems keep acknowledgement and transaction records, because many purge them sooner than anyone expects. Then set a routine for preserving the records you would need to establish when and how a claim was submitted.
02
Separate corrections from appeals
Not every denial needs an appeal. Work out whether the right next step is a corrected claim, additional information, a reconsideration, a formal appeal, or another payer-specific process, before anyone spends an hour writing a letter.
03
Track deadlines claim by claim
Appeal and resubmission requirements vary. Record the deadline that applies to each claim along with the source you used to determine it, instead of relying on one universal appeal window for everything.
04
Prioritize on more than age
Weigh financial value, time remaining, denial reason, documentation available, and how likely it is that further action is appropriate at all. The oldest claim in the queue is not automatically the most important one.
05
Keep the recovery record together
Hold the denial notice, claim documentation, correspondence, submission confirmation, appeal materials, payer response and remittance information in one place. A clear evidence trail is what makes follow-up and reconciliation quick instead of painful.
The denial decoder sorts any denial code for you at no charge, right now, no contact details required.
What organizations ask before they send the denials.
Q1
Will Soft Appeals replace my billing team?
No. Soft Appeals complements an existing billing operation. Your billing team keeps claim submission, coding, payment posting, routine corrections and the rest of its revenue-cycle responsibilities. We work the denied claims assigned to the recovery engagement and coordinate with the right person on your team when a claim needs additional information or internal action.
Q2
How is patient information handled?
Denied-claim recovery may require access to protected health information. Before PHI is exchanged, the applicable Business Associate Agreement is executed. We follow a minimum-necessary approach to information requests and use the designated processes and systems established for the engagement. The complimentary denial review does not require routine access to your EHR. Our data and security practices are set out in full on their own page.
Q3
How do you use AI?
Technology assists with administrative work: organizing information, research, workflow support, and preparing draft materials. It does not decide on its own whether a claim should be appealed, and it does not authorize submissions on a client's behalf. Appeal work is reviewed against the available claim information, the documentation, the payer requirements and the agreed workflow before anything is submitted. Where PHI is involved, technology use is governed by the privacy and security requirements that apply to the engagement.
Q4
How is recovered revenue verified?
Payers keep reimbursing your organization directly. Recovery is reconciled using the applicable payer remittance or payment documentation. For contingency-fee engagements, the Soft Appeals invoice identifies the recovery used to calculate the fee, so your organization can verify the amount against its own records.
Q5
Are all denied claims worth pursuing?
No. Some are better handled through correction or resubmission. Others need additional information, may no longer have a recovery pathway available, or may not justify further effort given the circumstances. Deciding where recovery effort should not go is part of the review, and saying so plainly is part of the job.
Q6
Will anything be submitted without our approval?
No. The engagement establishes the approval and authorization process before any payer submissions begin, and appeal materials are presented for your approval before they are submitted in your organization's name. Anything requiring coding, clinical, legal or other professional judgment outside the agreed scope is returned or escalated to the appropriate person rather than changed by Soft Appeals.
Q7
Why is the initial review complimentary?
Because the best way to evaluate a denial-recovery service is to start with the claims themselves. The initial review gives your organization a clear view of selected denials, recommended next actions, financial value and known time sensitivity, before you decide whether you want Soft Appeals doing the recovery work. The report stays yours either way.
Deeper questions about scope, PHI, security, AI, 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.
BAA before PHI
Minimum-necessary approach
No routine EHR access for the initial review
Client approval before submission
Direct payer-to-provider payment
Documented recovery activity
Start with 20 denials
See where recovery opportunities may exist.
Begin with a complimentary review of 20 recent denied claims. We put the privacy documentation in place, securely receive the agreed denial information, review the claims, and return an assessment of recommended actions, financial value and known time-sensitive items. Then you decide whether you want Soft Appeals involved in the recovery work. No obligation to continue.