The Revenue Execution Gap

Three revenue leaks. One execution layer. Closed 24/7

11.8% of claims are denied. 3–7% are underpaid. Claims past 120 days are nearly uncollectible. ANKA closes all three leaks—automatically.

ANKA sits downstream of your billing system, operating on claims already submitted to payers. From EOB receipt to aging AR to underpayment discovery—everything is worked 24/7. Your team handles claim submission, coding, and billing. ANKA handles everything after that: identifying appealable denials, recovering underpayments, resolving aged AR, and executing follow-up. EHR-agnostic. No rip-and-replace. No six-month implementation.

4 Weeks

Go-live timeline. While enterprise vendors demand 6–12 months.

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The Workflow

Without ANKA vs. with ANKA

Here is what happens to a denied claim in the real world.

Step	Without ANKA	With ANKA
1. EOB Received	Payer sends EOB. It sits in an inbox or EHR until someone has time to read it.	EOB lands. AI reads it in seconds. It extracts the denial reason, claim details, and payer rules.
2. Gather Clinical Documentation	Your billing staff spends 30–45 minutes finding the right clinical note, imaging report, or authorization form.	AI pulls clinical history from your EHR and cross-checks against payer requirements. Zero manual digging.
3. Write the Appeal	Someone writes the appeal—referencing clinical documentation and checking payer policy—taking ~20 minutes per appeal — but denials compete with charge entry, posting, eligibility checks, and patient calls for the same staff hours.	AI generates the appeal letter, cites the exact clinical evidence, and matches payer appeal guidelines. Ready to send.
4. Route for Review	The appeal sits in someone’s inbox. Review depends on the workload. Delays result in missed timely filing deadlines.	Your team reviews the 10% that require human judgment (unusual cases, missing documentation). The other 90% are submitted automatically.
5. Submit to Payer	Someone manually submits the appeal, tracks the submission date, and logs it in a spreadsheet—sometimes even forgets.	Appeals are submitted via the payer portal or mail. Submissions are logged automatically. Nothing falls through the cracks.
6. Track Outcome	Status checks involve payer calls, typically resulting in 15–30 minutes on hold, transfers, and limited resolution.	AI monitors appeal status automatically. When the payer responds, AI flags it. Your team sees the outcome in real time.
7. Close or Rework	The appeal gets paid or denied. If denied again, the claim moves to aged AR and is often written off as uncollectible.	Paid = closed. Denied again = AI reworks with a new approach, tracking through maximum appeal levels. Nothing is abandoned.

The difference isn’t in the process—it’s in the execution. ANKA doesn’t inform. It does the work.

Watch ANKA process a real claim from denial to recovery in 3 minutes

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Core Capabilities

Six capabilities that close the revenue execution gap

Unified AR queue: every claim from every system, ranked by recovery priority, with one-click actions.

Glass-pane interface

Unified AR view across EHRs, billing systems, clearinghouses, and payer portals. Single dashboard. No context switching. See all claims, denials, appeals, and follow-ups in one place.

AI-driven claim prioritization

Machine learning ranks claims by recovery probability, dollar value, aging, and payer behavior. Work the highest-value claims first. Don’t waste time on denials that won’t overturn.

Decision layer

Next best action decision engine. For each claim: Should we appeal? Rework? Request additional docs? Follow up with the payer? The system decides. You execute or override.

Autonomous resolution with human loop

AI auto-executes repeatable AR actions. Routes complex cases to humans. Voice AI handles phone follow-ups with payers. Your team stays in the loop on every decision.

Self-learning orchestration

System learns from outcomes over time. Which appeals work? Which payers overturn denials? Which follow-up strategies succeed? Routing and prioritization improve automatically.

Three-leak revenue intelligence

Maps all three revenue leaks in real time: denied claims (Leak 1), underpaid claims (Leak 2), and aging AR (Leak 3). Prescriptive insights for your CFO: where the money is leaking, why, and how to close it.

The Output

What an AI-generated appeal actually looks like

Not a template. Not a framework. An actual appeal letter, generated in seconds, ready to submit.

ANESTHESIA ASSOCIATES OF NASHVILLE
PO Box 1234, Nashville TN 37201
Invoice #: ANS-2025-047821

Date: February 10, 2025
Claim Number: CLM-5847291
Service Date: January 15, 2025
Patient Name: J. Thompson
Patient ID: 487291-B

RE: APPEAL OF CLAIM DENIAL – Medical Necessity

Dear BCBS Health Select Appeals Team,

We respectfully appeal the denial of the above-referenced claim dated January 15, 2025. The claim was denied on the basis of “medical necessity not established.” We provide clinical evidence supporting the medical necessity of the anesthesia services rendered.

CLINICAL JUSTIFICATION:

The patient underwent a left rotator cuff repair, a major surgical procedure. Per ASA guidelines and standard anesthesia protocol, general anesthesia with endotracheal intubation is the standard of care for this surgical intervention. The operative report documents a surgical time of 87 minutes—well within the parameters requiring general anesthesia for patient safety and surgical accessibility.

Per your medical policy guidelines (Policy #MA-2025-008, Section 4.2), general anesthesia is medically necessary when: (1) the procedure exceeds 45 minutes, and (2) the surgical complexity requires airway protection. Both criteria are met in this case.

SUPPORTING DOCUMENTATION:

Operative Report (January 15, 2025) – Surgical time: 87 minutes
Anesthesia Record – ASA Class II; general anesthesia with endotracheal intubation
Your Medical Policy #MA-2025-008 supporting this determination

Based on the clinical documentation and your own medical necessity guidelines, this claim should be reimbursed at the contracted rate of $487.00.

We request immediate review and payment of this appeal. Please contact us if additional information is required.

Sincerely,

Anesthesia Associates of Nashville
Appeals Team
Phone: (615) 555-0147
Email: [email protected]

This is a real example generated by ANKA. Names and dates changed for privacy. Clinical reasoning and evidence structure exactly as submitted to payers.

The Model

AI handles the 90%. Your team handles the 10% that matters

Human judgment where it’s needed. Automation everywhere else.

90%

What ANKA does

✓ Reads EOBs and denial reasons
✓ Pulls clinical documentation
✓ Writes appeal letters
✓ Submits to payers
✓ Tracks appeal status
✓ Escalates follow-ups
✓ Recovers underpayments
✓ Routes to your team only when needed

10%

What your team does

● Reviews unusual appeals
● Handles missing documentation
● Makes judgment calls on edge cases
● Manages high-value disputes
● Communicates with payers on complex issues
● Provides outcome-level oversight
● Focuses on strategy, not tasks
● Does the human work that matters

Your billing staff go from processing denials to managing outcomes. They shift from 8 hours of drudgery to 2 hours of actual decision-making. Turnover drops. Satisfaction rises. Revenue stops leaking.

Timeline

From contract to live execution. 4 weeks

Most healthcare IT implementations take 6–12 months. ANKA is different.

Week 1–2: connect

We integrate with your EHR (Epic, Cerner, athenahealth, others). Establish secure data pipeline. Map your claim structure. Zero patient data exposure until you approve.

Week 3–4: configure

Your team defines appeal thresholds, payer-specific rules, clinical pathways. We train your billing staff on the dashboard. Run dry-run appeals. You see output before anything goes live.

Week 4: go live

Go live with full denial volume. Your team monitors, flags exceptions, reviews outcomes. Appeal acceptance and collection data flows in real time. We iterate based on your feedback.

Week 4+: optimize

AR recovery kicks in. Underpayment monitoring goes active across all payers. Continuous optimization based on outcomes. Your revenue cycle works 24/7.

Traditional Enterprise RCM Vendor

6–12 months

Implementation. Integration. Testing. Training. Deployment. Then months of optimization.

ANKA

4 weeks

Connect. Configure. Execute. Live. While your team learns to trust the output.

The Architecture

Seamless integration, faster execution

ANKA doesn’t replace your EHR. It doesn’t demand data migration. It doesn’t need new infrastructure.

Post-claim positioning

ANKA operates downstream of billing. Your team controls submission, coding, and billing decisions. ANKA works everything after claim submission: denials, underpayments, follow-ups, aged AR.

Security first

We are SOC 2 Type II certified. A HIPAA BAA is executed before any data transfer occurs. Patient data is encrypted both in transit and at rest. All data is stored in the US. Audit logs are maintained for every transaction.

Plug-and-play payer integration

We’ve already mapped payer requirements for 100+ payers, including appeal formats, documentation rules, and timely filing deadlines. When a payer rule changes, we update it—you don’t.

Real-time execution

Denials are worked within hours, not days. Appeals are submitted immediately. No queues. No bottlenecks. You can see the work happening—in real time—on your dashboard.