Evidence in context
Connect each argument to its supporting records, correspondence, and documented review.
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Bring denial details, clinical evidence, contract terms, and applicable appeal requirements into one coordinated workflow—from initial review through submission and resolution.
Connect the payer response with the claim, account history, and reason for denial. Distinguish clinical issues from contractual or statutory questions, identify the appropriate appeal pathway, and assign ownership to the team best equipped to respond.
Organize relevant medical records, physician documentation, authorization history, coding detail, payer correspondence, and supporting contract provisions. Help staff develop a clear appeal narrative and flag missing documents before the packet moves to review.
Maintain the appeal level, deadline source, triggering event, submission method, and required supporting materials. Flag approaching deadlines, missing prerequisites, and overdue responses. Staff verify the applicable payer, plan, jurisdiction, and current requirements before relying on a due date.
Send clinical questions to clinical reviewers, coding issues to Coding, and contractual or statutory concerns to the appropriate specialists or legal counsel. Capture approvals, submission evidence, payer responses, and outcomes. Feed recurring denial patterns back into prevention and payer-performance review.
| Case / issue | Assigned review | Illustrative status |
|---|---|---|
| AP-201 · Medical necessity | Clinical / physician advisor | 5 days remaining · evidence needed |
| AP-202 · DRG downgrade | Coding / clinical validation | 12 days remaining · draft review |
| AP-203 · Payment delay | Payer specialist / counsel | Requirements validation |
✓ Denial notice and claim
✓ Authorization history
✓ Relevant clinical records
Pending: physician rationale
Due-date source: reviewed payer notice
Time remaining: 5 days
Owner: clinical appeals nurse
Next reviewer: physician advisor
Exigen brings the evidence together and flags the missing rationale. The clinical team validates the argument and supporting records before an authorized reviewer approves the packet for submission.
A payer specialist compares the payment history and correspondence with the relevant contract and applicable requirements. Any proposed statutory basis, filing deadline, or escalation route is reviewed for the specific plan and jurisdiction. Legal questions are routed to counsel; the system does not assume one rule applies to every payer.
All cases and countdowns are illustrative. Actual deadlines and appeal rights depend on the applicable rules and facts; this demonstration does not calculate legal deadlines or submit appeals.
ACME demonstration only. Illustrative data and workflows; no live accounts, bank files, or payments are processed on this page.
Connect each argument to its supporting records, correspondence, and documented review.
Show ownership, remaining work, and escalation needs before a filing window closes.
Use appeal outcomes and recurring patterns to inform clinical, coding, billing, and payer discussions.