Two problems, not one

Get paid on the ones they said no to.

Getting to yes and getting paid on the no are different jobs. Keep whatever gets your authorizations submitted — we work the ones that come back denied.

Half one

Submission — someone else’s

Deciding whether auth is required, assembling documentation, submitting cleanly. Real work, and we don’t ask you to rip it out.

Half two

The residual — ours

Appeals, reconsiderations, peer-to-peer prep. Every point of first-pass approval you don’t have is a denial someone has to work or write off.

Start a pilot →See every payer we cover

Denial received

Evidence matched

Package ready

Payer response · case 4417Denied · reason 4A

Inpatient level of care not established

Aetna · lumbar fusion · $18,400 at risk

“The submitted records do not document a trial of conservative therapy of sufficient duration, and the requested site of service is not supported by medical necessity criteria.”

Two assertions. Both are answerable from the chart and the contract — which is the entire job.

Appeal package · case 4417Ready for signature

Reconsideration — inpatient level of care, lumbar fusion

Aetna · CP-0214 rev. 06/2026 · denial reason 4A · $18,400

The plan’s criteria require six weeks of documented conservative therapy [§3.1]. The chart shows continuous physical therapy from 03/14 to 05/02 [PT notes], exceeding that threshold.

Advanced imaging within 90 days is on file as of 06/11 [MRI]. Site of service is set by the agreement, not by medical policy [§4.2].

Attending physician signature

Sources

PolicyCP-0214 §3.1 · refreshed 14d ago

ChartPT notes 03/14 — 05/02

ChartMRI 06/11 · lumbar

Contract§4.2 rate schedule

Policy and contract are labeled separately. A reviewer can open every one.

The payer said no. Watch what happens next.

Read the full package, de-identified →

That package did not exist twenty minutes earlier. Here is every step between the denial and the signature — and who does each one.

How an appeal is built

A denial comes back. Ninety minutes of someone’s day, or six of ours.

Nothing here decides medical necessity. The physician does — we assemble the argument and cite it.

01 · what came backDenied

Reason code 4A — level of care not established

“Submitted documentation does not establish medical necessity under the plan’s length-of-stay criteria.”

Appeal window30 days

Charges at risk$18,400

Staffed appeal today~90 min

02 · what we pull6 min

The payer’s own criteria, against your own chart

PolicyCP-0214 §3.1, §3.4 — cited, with the refresh date

ChartPT notes, op note, imaging, post-op vitals

Contract§4.2 rate schedule — the obligation policy doesn't state

FormsTX TDI, CMS Waiver of Liability — filled and named

03 · what you sendCleared

An appeal package the reviewer can audit line by line

Criterion-by-criterion rebuttal, every claim anchored to the document it came from, in the payer’s required format — handed to the specialist for signature.

Measured on one numberOverturn rate on denied authorizations.

None of it survives contact with a spreadsheet. It has to live somewhere a reviewer works all day.

The workspace

One case, one verdict, one next action.

Requirements on the left, the chart evidence that satisfies them on the right, the citation one click deep. Nothing is asserted that a reviewer can’t open.

The MeetsCriteria Denials list, demo data: denied cases sorted by appeal deadline, each with its payer, procedure and dollars at risk. The open case — a denied bariatric surgery with Elevance Health, $22,400 at risk, appeal due in 60 days — shows its progress from denial to sent-to-payer, the payer's stated denial reason, and a prompt to load the patient's chart from Epic. — Denials · soonest appeal deadline first, the payer's reason on topBook a walkthrough →“Every row resolves to a document, or it stays flagged.”

The contracts screen in a new workspace: one section per payer — Aetna, Amerigroup, Anthem and four more — each reading no contracts uploaded for this payer yet. — Your contracts, not just their policy
One slot per payer, empty until you fill it — this is a new workspace, so every row reads none uploaded yet. Once a contract is in, you can ask it questions, and its citations join appeal packages beside the policy ones, labeled separately, because an obligation is not a criterion.

The Recovery screen, demo data: overturn rate, dollars recovered and dollars still at risk; the pilot's return against what it cost, with the date it paid back; and every recovered dollar by case, each marked verified against the payer's payment. — Denial-to-cash, closed loop
What the pilot recovered against what it cost, and the day it paid for itself. Every recovered dollar is listed by case and marked verified when the payer's payment reference is on file — entered by a reviewer, never inferred. This is where an overturn rate stops being a promise and becomes a number.

Which leaves the only question worth asking before a pilot: why should you believe any of this?

What we put in writing

Four claims. All checkable before you sign anything.

Ask every vendor in this category the same four. Including us.

Provider side only

No payer product, no payer investors, no utilization-management contracts. Every other claim on this list a competitor could match by building it. This one they would have to unbuild. When you ask who else is on the other side of our table, the answer is nobody.

On the cap table

Every payer, published in full

Named payers, sourced to public policy documents, each source on its own refresh cadence and flagged — not silently served — once it goes stale. Counted per document, not per payer brand, so licensees sharing one corpus are counted once. We compete on whether you can audit a criterion, not on how many we claim.

Browse the whole list →

Da Vinci DTR + PAS conformance

Named conformance, not “FHIR-capable.” Tested and passing against Inferno, HL7’s own open-source reference validator — not a self-report — ahead of the CMS-0057-F compliance date of January 1, 2027.

Inferno-verified

Single-tenant per health system

One deployment, one tenant. PHI isolated to yours, encrypted at rest, with a documented auto-purge policy your security review can read before procurement starts.

In the security packet

Four claims, all checkable. One offer that puts them at risk.

Paid pilot · fixed scope · BAA first

Run it on your own denials. Judge the before-and-after in one meeting.

A paid pilot on a fixed volume of your own denials, measured on overturn rate — the number we’re willing to be judged on.

Step 01We sign a BAA and scope the pilot — a fixed volume of your own denials.

Step 02We return cited appeal packages, criterion by criterion.

Step 03You judge the before-and-after in one meeting.

Start your pilot

Jay Clem

Founding Partner, MeetsCriteria

You’ll talk to the person who builds it. Book a call first — we put a BAA in place before any patient data moves.

jay@meetscriteria.com Schedule online

Reply inside one business day.

Model your residual first →