Financial value
How much reimbursement is at issue on this claim.
Sample deliverable · Denial Recovery Assessment
See what your denial review will actually look like.
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.
Fictional claim information
No patient identifiers appear in this public sample
Your assessment is yours whether or not you continue
What you receive
One review. Five questions answered.
01
What was denied?
The payer, denied amount, denial category, service information and available denial reason, organized into one review instead of scattered across remittances.
02
What needs attention first?
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.
03
What is the recommended next step?
Each claim receives a recommended disposition: correct or resubmit, appeal, investigate, or close and deprioritize.
04
Why?
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.
05
What happens next?
Claims selected for recovery move into the appropriate Soft Appeals workflow, after your organization approves the scope.
Soft Appeals · Denial Recovery Assessment
Sample · fictional data
Organization
Example Specialty Group
Review period
Sample 90-day period
Claims reviewed
20 denials
Total denied amount
$14,850
Executive summary
Recommended disposition
Correct / resubmit
$2,750
5 claims
Appear to need correction or resubmission rather than a formal appeal.
Appeal
$6,400
7 claims
Available information supports further review through an appeal pathway.
Investigate further
$3,100
4 claims
Additional documentation, payer clarification or an internal decision is needed first.
Close / deprioritize
$2,600
4 claims
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.
How to read the assessment
- Priority tells you what deserves attention first.
- Recommended action tells you the proposed next step.
- Basis explains why that action is recommended.
- Timing identifies known deadlines or items needing confirmation.
- Status shows where the claim currently sits in the recovery process.
Claim worklist
| 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.
Financial snapshot
Total denied reviewed
$14,850
20 claims
Appeal recommended
$6,400
7 claims
Correction recommended
$2,750
5 claims
Further investigation
$3,100
4 claims
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.
Sample claim analysis
SA-002 · medical necessity denial
- What happened
- The claim was denied on the payer's stated medical-necessity determination.
- What was reviewed
- The available denial documentation and claim information, to identify the stated basis for the denial and the appropriate next-step pathway.
- Initial assessment
- On the fictional information in this example, the claim appears appropriate for further appeal review rather than correction or routine resubmission.
- What is needed
- Before submission, confirm that the supporting clinical documentation and any applicable authorization or coverage information required for the appeal are available.
- Recommended next step
- Prepare the appeal package using the applicable payer requirements and supporting documentation, then present the completed materials for client approval before submission.
- Timing
- The applicable appeal deadline should be confirmed against the governing plan and payer requirements before submission.
Recommendation basis
- Denial reason reviewed
- Available claim documentation reviewed
- Correction and resubmission pathway considered
- Appeal pathway considered
- Additional information requirements identified
- Timing requirements reviewed or flagged for confirmation
Pattern observations
Individual denials can reveal operational patterns. Alongside the claim-level recommendations, the assessment records recurring themes visible within the reviewed sample.
Authorization4 of 20 claims
Four of the twenty sample denials involve authorization-related issues.
Operational question: is authorization information consistently verified and retained before services are rendered?
Documentation3 of 20 claims
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?
Claim information5 of 20 claims
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.
Action items
Your team
- SA-003
- Provide available timely-filing evidence.
- SA-005
- Provide the requested supporting documentation.
- SA-008
- Confirm whether a corrected claim was previously submitted.
- SA-011
- Confirm payer correspondence received after the denial.
Soft Appeals
- SA-002
- Prepare the appeal package.
- SA-004
- Document the correction recommendation.
- SA-007
- Confirm the applicable payer appeal pathway.
- SA-001
- Confirm the filing deadline before any submission.
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.
The Recovery Lab is this same portfolio, live: sort the worklist, filter it, open any claim and read why each recommendation was made.
Recovery priority
How a claim gets its letter, and why it is not a probability score.
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.
Time sensitivity
Whether known timing requires prompt action, or a deadline still needs confirming.
Recovery path
Whether there is an identifiable next step based on the information available now.
Information readiness
Whether enough is available to proceed, or additional documentation is required first.
A
Immediate attention
Value, timing and an identifiable path all point the same way. These are worked first.
B
Review next
A clear next step, without the timing pressure that puts a claim in A.
C
Additional information needed
The path may be viable, but something has to arrive before anyone can act on it.
D
Close or deprioritize
The information, timing or value does not support spending more on the claim.
Claim status
Every assigned claim sits in exactly one status.
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.
Received
Under review
Additional information needed
Correction recommended
Appeal recommended
Client review
Approved for submission
Submitted
Payer follow-up
Additional review or escalation
Recovered
Closed
Two different opportunities
Recover today's denial. Learn from tomorrow's.
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.
If you choose to continue
The assessment becomes the recovery worklist.
You decide which eligible claims, if any, you want Soft Appeals to pursue. For approved claims, the next phase may include these steps.
01
Payer requirement research
Confirm the appropriate reconsideration, appeal, resubmission or other available recovery pathway for the claim.
02
Evidence organization
Identify and organize the available documentation relevant to the denial.
03
Appeal preparation
Prepare the appropriate appeal materials for client review.
04
Client approval
Nothing is submitted in your organization's name until the agreed approval process is complete.
05
Submission documentation
Record submission dates and the available delivery or acknowledgement evidence.
06
Follow-up tracking
Track payer responses, requests for additional information, relevant deadlines and next actions.
07
Recovery reconciliation
When reimbursement is received, reconcile the outcome against the applicable remittance documentation.
The complimentary 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.
Your denials · your assessment
See the same analysis applied to your claims.
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. Complimentary initial review, no obligation to continue.