What's the difference between provider-led and patient-led appeals, and why does it matter?

When the patient—not the provider—files the appeal, it activates mandated timelines (often 72 hours), qualified (human) reviewer requirements, access to insurer documents, and the option for independent external review. These protections often don't apply to provider submissions. Insurance coverage is a legal agreement between the patient and their plan. Patient-led appeals can combine the physician's justification with clinical research, policy arguments, legal references, and personal impact—resulting in a more persuasive submission. Claimable's patient appeals have an ~80% success rate for established conditions, with most approvals in under 10 days.

How does AI-powered appeals automation reduce our cost per case while maintaining quality?

Traditional manual appeal processes are costly, requiring proportional headcount increases as denial volumes rise. Claimable's AI-powered platform fundamentally changes this equation through scale without staffing, quality that wins, and strategic efficiency.

Can your platform integrate with our existing hub services vendor and specialty pharmacy partners?

Yes. Claimable is designed for flexible integration across diverse operational models, from exclusive specialty pharmacy relationships to multi-vendor hub environments. For specialty pharmacy partnerships, hub services vendors, and multi-pharmacy environments, Claimable provides seamless integration options.

What's the typical implementation timeline, and what does launch readiness require?

Implementation typically takes weeks, not months, with first successful appeals within 2–3 weeks.

How can appeals data strengthen our payer contracting negotiations?

Appeals data creates a new category of leverage in payer negotiations by documenting systematic denial patterns, demonstrating the burden imposed on patients and providers, and proving the medical necessity of coverage. Market access teams using Claimable data can negotiate lower prior authorization requirements, establish expedited review pathways, secure reasonable coverage criteria, and build case for preferred formulary positioning.

How do you ensure HIPAA compliance and data security?

Claimable maintains healthcare-grade infrastructure with comprehensive compliance frameworks. Claimable runs on HIPAA-compliant, AWS-hosted infrastructure with BAAs in place, is HIPAA certified by Workstreet (November 2025), and is actively pursuing SOC 2 Type II certification. We use strict role-based access, MFA, and full audit logging. All data is encrypted in transit and at rest. Patients receive clear consent disclosures and can control who accesses their data.

How do provider and patient appeals work together? Should they be sequenced or run in parallel?

Appeals can be run sequentially or in parallel. Sequential (provider first, patient second) is ideal when payers require HCP input or when complex clinical evidence is needed. Patient-first is useful when provider capacity is limited. Parallel is best for high-stakes or time-sensitive therapies. Claimable coordinates submissions to keep messages consistent.

What does 'human-in-the-loop' mean for AI-generated appeals, and how do you prevent errors?

Claimable uses a human-in-the-loop model where AI generates draft appeals, but trained staff or patients review, edit, and approve every submission before it goes out. This prevents errors through expert-curated evidence databases, validation checks, user review and editing, and compliance safeguards.

What makes Claimable different from other AI appeal platforms?

Claimable is the only AI platform built specifically for fighting unjust insurance denials. It puts the patient story at the center, uses expert-curated clinical, policy, and legal evidence, matches evidence to the exact treatment-and-condition pair, evaluates insurer errors and patient rights, tailors each appeal using over a million strategy combinations, automates fax and mail submission, never leaves users at a dead end, and is designed to work with enterprise businesses with privacy, security, and compliance safeguards.

CLAIMABLE FOR Health Systems

Overturn denials at scale with AI appeals

Combat rising denials with automated appeals – so patients get the care they need, staff focus on what matters, and every appeal makes the next one smarter.

More patients get approved with fewer delays

Give your teams better tools, not more paperwork

Unclog your RCM and streamline operations

Our Work and Stories Covered In:

Denials rates are rising.

Manual appeals can't keep up.

84% of large insurers now use AI to process denials, turning decisions that once took days into seconds. Yet most health system teams are still appealing one at a time, spending hours each week on manual processes – with little insight into what's working.

The result? Denials go unchallenged. Patients face treatment delays. And 46% abandon treatment entirely – not because the care wasn't needed, but because the process to get it approved was.

Insurers have automated denials at scale. Now it's your turn. It's time to give your team the tools to fight back, and get your patients the care they deserve.

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AI APPEALS BUILT FOR COMPLEX CARE

Your denial defense system

One platform. Streamlined integration. Smarter with every outcome.
Automate and scale denial management with Claimable.

<10
DAYS

AVERAGE RESPONSE
Unclog your RCM and get
patients answers, fast

OVER
80%

WIN RATE
More patients get approved for
needed care

15+
HOURS

SAVED PER APPEAL
‍Reduce the time and
staff it takes to appeal

$30+
MILLION

UNLOCKED VALUE
Proven success driving
care access in complex specialties

An integrated appeals solution

Claimable turns denial management from a cost center into an operational advantage – with seamless integration, enterprise-grade compliance and the sophistication to handle complex denials.

Integrate

Connect to your existing EHR and RCM systems – no new platforms, no disruption to your workflow.

Generate

Generate physician-quality appeals in minutes, fully customized to every patient and denial.

Track

Follow every appeal from submission to resolution – patients and staff always know where things stand.

Optimize

Learn from every outcome to strengthen strategies, reduce denials, and improve operations.

OUR TECHNOLOGY

Purpose-built for complex denials

Go beyond billing corrections and coding mistakes with an AI designed to handle complex care appeals.

From medical necessity to step therapy, Claimable's AI builds each appeal from clinical evidence, policy analysis, and legal leverage. Our proprietary database powers appeals with millions of evidence-strategy combinations tailored to each case – not templates insurers can learn to ignore.

✓ Trained on 4m+ clinical, legal and policy datapoints
✓ Customized to every denial, condition, insurer, and patient
✓ Continuously learning to make each appeal stronger

OUR EXPERIENCE

Stronger appeals, happier patients

Enhance your appeals workflow with the power of patient appeals.

Unlock additional levels of review and rights that only the patient can assert, giving you more ways to overturn every denial. Patients who go through Claimable feel supported, not sidelined. That shows up in outcomes, satisfaction scores, and your institution's reputation.
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✓ Activate legal protections provider appeals can't access
✓ Seamless data flow for no extra burden on clinical staff
✓ Rated 5 stars on Google – patients love Claimable

See everything, improve everything

The denial intelligence your team has never had.

Claimable centralizes denial data into a real-time dashboard: which payers deny most, which therapies face the highest barriers, which strategies win. Powerful insights enable your teams to prioritize resources where patients are most at risk of losing access, and gives your contracting team real leverage at the negotiating table.

✓ Analyze by payer, therapy, denial type, and outcome
✓ Case-level tracking, so your team always knows status
✓ Denial pattern data arms payer negotiations and reduces future denials

Seamless integration with your systems

Claimable's API-driven architecture integrates seamlessly with your existing tech stack. No new platforms to learn. No rip-and-replace.

Get your data flowing automatically – and give your staff an easy, centralized appeals dashboard that works alongside the tools they already use.

✓ API-driven architecture designed for existing EHR and RCM environments
✓ Multiple integration options from plug-and-play to bespoke
✓ Support materials and custom trainings for easy use

Automation built on compliance

Scale confidently with workflows designed for healthcare regulatory requirements from day one.

✓ HIPAA ✓ SOC2 ✓ AKS/FCA ✓ PV/AE

WHO WE WORK WITH

Designed for complex denials

Claimable's AI builds robust, clinically-backed appeals that justify coverage in complex situations, including those with limited clinical data and murky coverage criteria.

Oncology

Novel therapies face high denial rates and require extensive evidence. Appeals with the latest trial data, FDA labels, and clinical guidelines – and get patients to life-saving treatment faster.
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Infusion Centers

High-cost therapies require extensive documentation and face scrutiny. Standardize quality across providers. Automatically appeal post-service denials to prevent bad debt write-offs.
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Rare Disease

Limited clinical data makes appeals challenging. Our AI incorporates FDA approvals, case studies, and clinical rationale specific to rare conditions, increasing wins on tough cases.
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Getting started is easy

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1

Discover

We assess your denial landscape, systems, and the specialties where patients are getting stuck

2

Configure

Customize Claimable for your service lines, workflows, and compliance requirements

3

Launch

Go live with team training, patient resources, and dedicated support — in weeks, not months

Don't let denials decide who gets care.

See the difference Claimable can make: Drive efficiency, reduce RCM clog and improve patient satisfaction – all without adding admin work.

Unlocked over $30 million in claim value

Saved thousands of hours of staff time

Won over 80% of appeals, most closed in 10 days