A submitted appeal.
Sending the appeal is work, not recovery. On its own it produces no invoice.
Soft Appeals · pricing and engagement
Start with the claims before you commit to recovery work.
Your first 20-denial review is complimentary. You receive a Denial Recovery Assessment showing the recommended action, financial value, priority, known time sensitivity and the information still required for the claims reviewed. If you then engage Soft Appeals for eligible recovery work, the standard commercial-claim model is recovery-aligned: 25% of verified recovered reimbursement attributable to the recovery engagement. The payer continues paying your organization directly, and Soft Appeals never takes custody of payer reimbursement.
No obligation after the assessment
No monthly retainer under the standard model
Payer pays your organization directly
Invoice follows verification, not submission
Initial 20-denial review
$0
Complimentary assessment
No obligation to continue. The assessment is yours whether or not you engage Soft Appeals afterwards.
Eligible commercial recovery
25%
Of verified recovered reimbursement
Attributable to the recovery engagement, calculated from what was actually recovered rather than what was originally denied.
No verified recovery
$0
Recovery fee for that claim
Under the standard contingency model, a claim producing no qualifying verified recovery generates no recovery fee.
Eligibility and pricing are confirmed before recovery work begins. Certain claims, payers, programs or scopes may require different terms. Individual claims from $150, with smaller claims worked in batches where the payer's process allows one submission to cover several.
How the standard recovery fee works
The fee exists only after the money does.
For eligible claims accepted under the standard contingency model, Soft Appeals earns a fee only after qualifying reimbursement attributable to the recovery engagement has been verified.
If an eligible denied claim produces $2,000 in verified recovered reimbursement after Soft Appeals recovery work, the standard 25% recovery fee would be $500. Your organization receives the payer payment directly, and Soft Appeals then invoices the applicable fee.
If only part of the denied amount is recovered, the fee is calculated from the verified recovered amount rather than from the original denied amount.
Definitions that prevent arguments
What counts as a verified recovery?
For standard contingency engagements, a recovery generally means payer reimbursement received by the client after Soft Appeals begins authorized recovery work on the assigned claim, and that can reasonably be attributed to that work. Verification is based on appropriate payment or remittance documentation.
01
Electronic remittance advice
The standard source, where your systems produce one.
02
Explanation of payment
Where the payer issues one for the claim.
03
Payer remittance
The payer's own record of what it paid and against what.
04
Documented claim reprocessing
Where the payer reprocessed rather than issuing a new decision letter.
05
Other payment documentation
Anything that reasonably demonstrates the reimbursement was received.
06
Another agreed source
Where your systems produce something more reliable, that can be the agreed source instead.
The engagement terms establish the final definition used for your relationship. This page explains the model. The agreement is what defines it, and where the two differ, the agreement controls.
What is not automatically treated as a Soft Appeals recovery.
The recovery fee is not meant to apply simply because money appeared on an account during the engagement. These are the cases that get excluded, and naming them now is cheaper than arguing about them later.
01
Payment received before recovery work began
If the payer had already paid the claim before the recovery engagement started, that is not a Soft Appeals recovery.
02
Unrelated reimbursement
Payments associated with other claims or services are not included just because they arrived during the engagement.
03
Patient payments
The standard model applies to qualifying payer reimbursement, not to unrelated patient payments.
04
Duplicate or erroneous payments
Amounts that are clearly duplicate, mistaken or subject to immediate repayment are not treated as confirmed recovery because they briefly appeared on a remittance.
05
Claims outside the agreed scope
No recovery fee is charged for unrelated claims that were never accepted into the engagement.
Where attribution is unclear, your organization and Soft Appeals resolve it using the claim record and the applicable remittance documentation before any invoice is issued.
Partial recovery
A partial recovery is still a recovery.
Under the standard contingency model, the fee is calculated from the qualifying amount actually recovered, not from the full amount originally denied. Soft Appeals does not charge a percentage against reimbursement that was never received.
Interest and other amounts
Not every payment is only reimbursement.
Some payer payments may include interest or other amounts alongside the reimbursement. Whether those are included in the fee calculation is established in the engagement terms before recovery work begins.
Soft Appeals does not assume that any given claim is entitled to interest, penalties or additional payment, and does not promise them.
When Soft Appeals invoices
An expected payment is not a verified recovery.
The standard recovery fee is triggered after qualifying reimbursement has been verified according to the engagement terms. Three things that do not trigger it, and one that does.
A favourable payer letter.
A decision in your favour without verified reimbursement does not automatically trigger anything.
Verified reimbursement.
Once recovery is verified, Soft Appeals issues an invoice identifying the applicable claim and the recovery amount used to calculate the fee, so your team can check it against its own records.
What an invoice looks like
Every fee traces back to a claim and a document.
Soft Appeals · recovery reconciliation
Sample · illustrative
ClaimSA-024
Original denied amount$3,200
Verified reimbursement$2,400
Verified againstRemittance advice
Standard recovery rate25%
Payer paymentDirect to client
Soft Appeals fee$600
Illustrative example only. Actual engagement terms control. Note that the fee is calculated from the $2,400 actually recovered, not from the $3,200 originally denied.
The complimentary review
What free includes, and what it does not.
The initial review exists to help you decide where further recovery effort may be appropriate. It is an assessment, not twenty appeals at no charge, and being clear about that up front is fairer to both sides.
Included in the review
For each of the 20 claims.
- Denial categorization
- Denied amount
- Recommended disposition
- Recovery priority
- Known time-sensitive items
- Additional information requirements
- The basis for the recommendation
- Proposed next ownership
Not included in the review
These begin only under an approved engagement.
- Preparation of 20 complete appeals
- Payer submission
- Ongoing payer follow-up
- Unlimited claim research
- Clinical or coding review
- Legal analysis
- Broad revenue-cycle consulting
- Ongoing denial management
The assessment belongs to your organization whether or not you engage Soft Appeals afterwards.
Government-program and specially regulated claims
Do not assume the standard model applies to every claim.
Medicare, Medicaid, other government-program claims, certain managed-care arrangements, and claims subject to specific contractual or legal restrictions may require different engagement terms, or may sit outside the standard contingency scope entirely.
Eligibility and pricing for those claims are determined before any recovery work begins on them.
Soft Appeals does not apply the standard contingency model to a claim where doing so would conflict with applicable law, regulation, contract, payer requirements or the agreed engagement structure. The rules governing these arrangements are fact-specific, and reducing them to a single sentence on a pricing page would be the wrong way to decide them.
Contracts, not only statutes
Payer and client agreements can affect the engagement.
Not every restriction comes from a statute. Provider agreements, payer contracts, network terms, delegation arrangements and other contractual requirements can affect how a claim may be handled or how services may be compensated.
Your organization remains responsible for identifying the contractual restrictions it knows about, including anything in an existing billing-company agreement about third-party appeal work.
Where an applicable restriction is uncertain, Soft Appeals may ask for clarification before accepting a claim or a scope. That is a slower start and a better one.
The awkward cases
Three situations that decide whether pricing is honest.
These come up in real engagements, so they are settled here rather than negotiated when the invoice arrives.
01
The claim was already in progress
Soft Appeals may still take it, but the history is reviewed first: what has already been submitted, what was completed before the engagement, what deadlines or review rights remain, what information is still required, and whether future reimbursement can reasonably be attributed to Soft Appeals recovery work. Claims with substantial pre-existing recovery activity may need modified terms so attribution is clear before work continues.
02
The claim is paid while recovery work is underway
The payment is reviewed against the claim history and the engagement record. A payment arriving during an engagement does not by itself establish that Soft Appeals earned a fee. The recovery has to meet the attribution and verification requirements in the engagement terms, and where the source is unclear, the claim is reconciled before any invoice is issued.
03
The money is later reversed or recouped
A payer can reverse, offset or recoup a payment after issuing it. The engagement terms establish how a confirmed post-payment reversal affecting previously invoiced recovery is handled. Soft Appeals does not treat a temporary payment as permanently resolved when later payer activity changes the outcome.
Ending an engagement
Nobody should be guessing who owns an active claim.
You may stop assigning new claims to Soft Appeals, subject to the engagement terms. The service agreement establishes how claims already in progress are handled: work already completed, pending payer submissions, claims awaiting a decision, future reimbursement attributable to work completed before termination, outstanding invoices, access termination, and the return, destruction or retention of information.
No obligation from the assessment
The review does not commit you to anything.
Receiving the complimentary Denial Recovery Assessment does not require your organization to place those claims with Soft Appeals. You decide whether to proceed.
If you continue, the service scope, fees, responsibilities, privacy terms, approval process and the rest of the engagement requirements are established before any paid recovery work begins.
Client responsibilities
A contingency fee does not mean you do nothing.
Recovery work needs your organization at several points. Naming those points is part of the pricing, because a claim that stalls waiting on a document is a claim nobody gets paid for.
01
Accurate claim and denial information
What you send is what the assessment is built from.
02
Requested supporting documentation
Provided when asked, with the deadline it affects attached to the request.
03
Authorized contacts
Who can give instructions, and who can approve a submission.
04
Clinical or coding input
Where a claim needs judgment that has to come from your side.
05
Relevant prior appeal activity
Disclosed up front, because it changes both the pathway and the attribution.
06
Review and approval of submissions
Nothing goes out in your name until you have approved it.
07
Client-side billing actions
Corrections and resubmissions that belong inside your own workflow.
08
Relevant payer communications
Anything the payer sends you directly that affects an assigned claim.
09
Remittance information for reconciliation
So recovery can be verified rather than assumed.
10
Known contractual restrictions
Anything in your agreements that affects how a claim can be worked or paid.
Soft Appeals identifies the required client actions and keeps them visible in the recovery workflow, so nothing waits on a request nobody saw.
What the fee is not based on
Five things the percentage is never calculated from.
01
The original billed charge
Billed charges commonly run well above the contracted rate. A fee built on them would inflate itself.
02
The total denial inventory
Reviewing claims is not the same as recovering them, and reviewing is free.
03
An appeal, because it was submitted
Effort is not an outcome. Submission produces no fee on its own.
04
A predicted recovery amount
No estimate anywhere in the assessment ever becomes an invoice.
05
Money that cannot be tied to the work
If the recovery cannot reasonably be attributed to the assigned recovery work, it is not a Soft Appeals recovery.
The fee is based on verified qualifying recovery under the applicable engagement terms, and nothing else.
Pricing FAQ
What people ask before signing anything.
Q1
Is the initial review really complimentary?
Yes. There is no charge for the initial 20-denial assessment, and your organization keeps the assessment whether or not it continues.
Q2
Is there a setup fee?
Not for the standard complimentary assessment. If a future engagement needs a materially different onboarding or service scope, any separate charge is disclosed before work begins.
Q3
Do you charge monthly?
Not under the standard recovery-aligned model. The engagement is not a subscription for keeping claims in a queue. Other or custom services would be priced separately and agreed separately.
Q4
Do we pay if an appeal loses?
Under the standard contingency model, a claim that produces no qualifying verified recovery generates no recovery fee.
Q5
Who receives the payer money?
Your organization. Soft Appeals does not need reimbursement redirected to it under the standard workflow, and does not take custody of payer funds.
Q6
Can we choose which claims you work?
Yes. The assessment helps determine which claims warrant action, and the recovery scope is agreed before any paid work begins.
Q7
Is every commercial claim automatically eligible for 25% pricing?
No. Eligibility can depend on the payer, the plan, contractual restrictions, previous work on the claim, the claim type, legal requirements, the scope and other circumstances.
Q8
What about Medicare or Medicaid?
Do not assume those claims fall under the standard commercial contingency model. Government-program claims are reviewed separately for appropriate scope and pricing before any work begins.
Q9
What if our payer pays while you are reviewing the claim?
The claim is reconciled to determine whether the payment qualifies as a Soft Appeals recovery under the engagement terms. A payment arriving during the engagement does not automatically create a fee.
Q10
Can we see how the fee was calculated?
Yes. Recovery is reconciled against the applicable remittance or payment documentation, and the invoice identifies the recovery amount used for the calculation.
Start with the assessment
You do not have to agree to recovery fees to find out what needs attention.
Begin with 20 recent denied claims. Soft Appeals returns an assessment showing recommended actions, priority, denied financial value, known time-sensitive items and the information still required. Review the findings first. If you then want Soft Appeals to pursue eligible claims, the recovery scope and pricing are established before any paid work begins. No obligation to continue after the initial assessment.