Use cases

The situations we are built for.

Five ways practices put Prexisio to work. Each one starts the same way: one file your billing system already exports, no software to install, and a human reviewing everything payer-facing.

Small-balance write-off recovery Underpayment recovery against contract rates Aged AR follow-up Denied claim reconsideration and appeal Pre-submission denial prevention

Recovery

Small-balance write-off recovery

The situation

Every practice has a standing pile of claims that were individually never worth the labor to chase. A denied claim for a modest balance needs someone on hold with the payer, and by the time they get an answer, the labor has cost more than the claim. So the balance gets written off, not because the money is not owed, but because chasing it never penciled.

What Prexisio does

You place the pile with us in one file. Before anyone works a single claim, a prediction engine trained on your own claims history evaluates every one and sorts them: claims with a realistic path to payment, claims that are gone, and claims a person needs to look at. Your staff never sits on hold for a claim that was never coming back, and the claims worth working get worked with the correspondence already drafted for human review.

What you receive

A claim-by-claim triage read with reasons, an activity log for every worked claim, and a statement showing gross recovered, our fee, and your net. Contingency pricing, so the pile costs you nothing to find out about.

Recovery

Underpayment recovery against contract rates

The situation

The payer paid, so the claim looks closed. But the payment was below your contracted rate, and nobody compared the remittance against the fee schedule line, because nobody has time to do that for every claim. The shortfall is invisible unless someone goes looking for it.

What Prexisio does

You provide your payer contracts during setup. Prexisio resolves every placed claim against the contract line that governs it, comparing what was paid against what the contract says should have been paid. Where a real shortfall exists beyond tolerance, we pursue the difference with the contract reference in hand. Where the payment was actually correct, we tell you that too.

What you receive

A list of verified underpayments with the contract basis for each, payer review requests drafted for human approval, and recovered shortfalls proven on your statement.

Recovery

Aged AR follow-up

The situation

Claims with an open balance, no denial, and no payment. They were submitted, nothing came back, and they quietly aged past the follow-up list. Some are stuck in payer processing. Some need one status check and a nudge. Some are approaching filing deadlines that will turn them into permanent losses.

What Prexisio does

Every aged claim gets evaluated for its recovery path before work begins, including how close it sits to the filing and appeal windows for its payer. Claims inside the window get status checks and follow-up. Claims where the rights have expired get declined with that reason stated, so you know exactly which money is recoverable and which is gone.

What you receive

A prioritized follow-up operation on the claims that can still pay, a logged record of every payer touch, and an honest accounting of the claims that aged out.

Recovery

Denied claim reconsideration and appeal

The situation

Denials with defined paths back to payment: authorization absent, information missing, coding and modifier disputes. Many were never appealed because appealing takes drafting time nobody had, and the reconsideration window quietly closed on money the practice earned.

What Prexisio does

Each denial code carries a strategy. Authorization denials get the authorization evidence path. Information denials get resubmission with the missing element identified. Coding disputes get the corrected claim argument. The letters arrive drafted with the claim facts filled in and placeholders for anything we do not hold, and a person reviews every one before it reaches a payer. Nothing is sent automatically.

What you receive

Appeals and reconsideration requests built claim by claim, an evidence checklist showing exactly what is present and what you need to supply, and outcomes recorded so the next appeal is smarter than the last.

Prevention

Pre-submission denial prevention

The situation

The recovery pile refills every month because the same denials keep happening upstream. The payer behavior that caused last quarter’s write-offs is still operating on this week’s submissions, and generic claim scrubbers cannot see it because they check rules, not your payer history.

What Prexisio does

Prexisio trains on twelve months of your adjudicated claims and evaluates every pre-submission batch against your own payer behavior. Certain losses get blocked outright before any model runs: claims past timely filing, deleted diagnosis codes, procedures that do not match their authorization. Everything else is predicted, with the reason and the fix. Your billing team receives a prioritized work order, not a dashboard.

What you receive

A hold, fix, and send work order for every batch, drafted correspondence where the fix requires it, and a pattern report for leadership naming the payers and procedures behind the losses. Every recovered claim also trains this engine, which is how the pile stops refilling.

Not sure which one fits?

Send one file and we will tell you. Most practices discover they have three of these situations at once.

Start with one file