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. EHR-agnostic. No rip-and-replace. No six-month implementation.

ANKA sits downstream of your billing system — working everything after claim submission, 24/7.

HIPAA Compliant 4 weeks to go live EHR-agnostic
ANKA in Action Watch
The Workflow

Without ANKA vs. with ANKA

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

Step Without ANKA Recommended With ANKA
1. EOB Received Payer sends EOB. It sits in an inbox until someone has time to read it.Delay: hours to days EOB lands. AI reads it in seconds — extracts denial reason, claim details, and payer rules automatically.Time: < 30 seconds
2. Gather Documentation Billing staff spends 30–45 min finding the right clinical note, imaging report, or auth form.Delay: 30–45 min per claim AI pulls clinical history from your EHR and cross-checks against payer requirements. Zero manual digging.Time: < 60 seconds
3. Write the Appeal Someone writes the appeal — but denials compete with charge entry, posting, and patient calls for the same staff hours.Delay: ~20 min, often skipped AI generates the appeal letter, cites exact clinical evidence, and matches payer appeal guidelines. Ready to send.Time: < 2 minutes
4. Route & Submit Someone submits via portal — if it ever gets submitted. 65% of denied claims are never reworked.Result: most go unworked Complex cases routed to your team with full context attached. Routine cases auto-submitted immediately.Result: 100% worked
5. Track & Follow Up Outcome tracking is manual. Nobody calls the payer. Timely filing deadlines pass. Revenue is written off.Result: permanent revenue loss ANKA tracks every submission, escalates non-responses, follows up with payers, and monitors for resolution.Result: recovered revenue
Core Capabilities

Six capabilities that close
the revenue execution gap

Everything ANKA does lives downstream of claim submission. Your team controls billing. ANKA controls recovery.

01

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.

02

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.

03

Decision layer

Next best action decision engine. For each claim: appeal? rework? request docs? follow up? The system decides. You execute or override. Every decision is explainable and auditable.

04

Autonomous resolution with human loop

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

05

Self-learning orchestration

System learns from outcomes continuously. Payer-specific denial patterns are identified. Appeal templates improve. Routing logic sharpens. No manual rule updates — it just gets better.

06

Three-leak revenue intelligence

Identifies underpayments at CPT-code level, surface systematic denial patterns by payer, and flags aged AR before timely filing deadlines close the recovery window. Prescriptive insights for CFOs.

The Output

What an ANKA-generated appeal looks like

Not a template. Not a framework. An actual appeal letter — generated in seconds, clinically grounded, ready to submit directly to the payer.

Clinically grounded Payer-specific format Ready in < 2 min Ready to submit
ANESTHESIA ASSOCIATES OF NASHVILLE Claim #CLM-5847291 · Invoice #ANS-2025-047821
ANKA Generated
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
Dear BCBS Health Select Appeals Team,
RE: APPEAL OF CLAIM DENIAL – Medical Necessity
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]
The Model

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

Human judgment where it’s needed. Automation everywhere else. Your billing staff shift from processing to managing.

90%
What ANKA Does

AI executes at scale — 24/7

  • Reads EOBs and denial reasons
  • Pulls clinical documentation
  • Writes and submits appeal letters
  • Tracks appeal status with payers
  • Escalates non-responses
  • Identifies and disputes underpayments
  • Works aged AR before deadlines pass
  • Routes to your team only when needed
Your billing staff go from processing denials to managing outcomes — from 8 hours of drudgery to 2 hours of actual decision-making.
10%
What Your Team Does

Human judgment on the cases that need it

  • Reviews unusual or complex appeals
  • Handles missing documentation
  • Makes judgment calls on edge cases
  • Manages high-value payer disputes
  • Provides outcome-level oversight
  • Focuses on strategy, not tasks
  • Communicates on complex payer escalations
  • Does the human work that actually matters
Turnover drops. Satisfaction rises. Revenue stops leaking.
Timeline

From contract to live execution.
4 weeks.

Most healthcare IT takes 6–12 months. ANKA is different by design.

Week 1–2

Connect

  • Integrate with your EHR (Epic, Cerner, athenahealth, others)
  • Establish secure data pipeline — encrypted in transit
  • Map your claim structure and payer contracts
  • Zero patient data exposure until you approve
01
Wk 1–2
02
Wk 3–4
Week 3–4

Configure

  • Your team defines appeal thresholds and payer-specific rules
  • We train your billing staff on the dashboard
  • Run dry-run appeals — you see output before anything goes live
  • Validate clinical pathways and documentation logic
03
Wk 4
04
Wk 4+
Week 4+

Optimize

  • AR recovery kicks in across aging claims
  • Underpayment monitoring activates across all payers
  • Continuous optimization based on outcomes
  • Your revenue cycle works 24/7 — without new headcount
6–12 months
Traditional enterprise RCM vendor implementation timeline
4 weeks
ANKA — from contract signed to live execution
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

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

Plug-and-play payer integration

Already mapped payer requirements for 100+ payers — appeal formats, documentation rules, 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. No end-of-month batch processing. Claims are processed as they arrive — around the clock.