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Appeal No. 0001 / Filed: 2024
§ 00 — The Hook

Insurers use AI to deny claims.

We build AI agents to fight back.

Send us your denied claims. Our autonomous agents read the clinical charts, cross-reference payer policies, draft the appeal letters, and file them on your behalf. You pay only when revenue is recovered.

↳ No software to learn. No staff to train. We handle the appeal end-to-end.

Agent drafting · 00:03
appeal_8472.docx
Re: Appeal — Denied Claim #8472
To the Medical Director,

I am writing to formally appeal the denial of claim #8472 for L4-L5 transforaminal epidural steroid injection. The denial cites “lack of medical necessity,” however the clinical record demonstrates...

[Citation 1] Per CGS LCD L33515, Section 4.b: epidural injection is medically necessary when conservative therapy exceeds 6 weeks...

Per the patient's chart, conservative management was pursued for 8 weeks without resolution...

5 citations·ICD-10: M54.5·Policy: CGS-LCD-L33515·Confidence: 94%
Filed
17 appeals filed
by our agents this hour
§ 01 — The Problem

The Bureaucratic Bottleneck

US healthcare loses $250B annually on administrative friction. Payers weaponize that friction with automation. Clinics fight back with sticky notes and overtime — a war they cannot win by hand.

i.

Payers auto-deny

Payers use AI to auto-deny high-dollar procedures — often batch-rejecting entire categories of specialty care without a clinician ever reviewing the chart. The denial is the default; the appeal is the exception.

ii.

Manual appeals are slow

Nurses and billing staff spend hours reading 50-page clinical charts just to draft one appeal letter. The math never works: there are more denials than hours in a day, so most go unchallenged.

iii.

Revenue left on the table

Clinics leave hundreds of thousands of dollars on the table to un-appealed denials — write-offs that quietly erode margin, capacity, and the ability to invest in care.

§ 02 — The Solution

From denial to recovered revenue in 3 seconds.

Four autonomous steps.
Zero work for your team.
We handle the entire appeal.

01.

Ingest

Send us your denied EOBs and clinical notes. Our agents ingest faxes, PDFs, and EHR exports in any format — no template engineering required.

02.

Analyze

AI extracts ICD-10 codes, CPT procedures, and clinical context, then maps the payer's stated denial reason to the relevant medical necessity criteria.

03.

Research

RAG searches 200-page payer policy manuals, LCDs, and NCDs in milliseconds — surfacing the exact clauses that justify coverage for this procedure.

04.

Draft

We generate a legally sound, fully cited appeal letter tailored to the denial reason — and file it on your behalf. No clinician review required.

§ 03 — The Moat

The Payer Denial Rules Graph

Every time an appeal is won, Veldarion learns the exact semantic triggers that force insurers to capitulate. The more claims we process, the higher your approval rate.

Software is easy to copy. A trained agent network is not. Each overturned denial becomes a permanent edge in the rules graph — compounding knowledge that no payer can defuse and no competitor can replicate.

+18%
Win rate grows
3s
Cycle time
Compounding edge
LCDNCDPolicyClinicalCMSStatuteCignaUHCAetnaBCBSHumanaCVSVELDARIONCORE
rules_graph.livecycle 4,182
12 nodes onlinev3.2.0
§ 04 — Pricing

Pure Found Money.

No seats, no tiers, no SaaS tax. We align incentives by getting paid only when you do.

$0 Upfront
Veldarion Contingency Agreement
10%

of recovered revenue

$0 upfront. $0 monthly SaaS fees. If we don't recover your denied claims, you don't pay us a dime.

  • Unlimited appeal generations
  • EHR integration (Epic, Athena, eClinicalWorks)
  • Real-time ROI & win-rate dashboard
  • White-glove onboarding with clinical SMEs
  • SOC 2 Type II / HIPAA-aligned delivery
  • Cited, audit-ready appeal letters
Contact Us to Begin

↳ Send us a denied claim. We handle the appeal end-to-end and file it for you.

§ 05 — Final Brief

Stop letting AI deny your claims.

Send us your denied claims. Our agents read the charts, find the policy clauses, write the appeals, and file them on your behalf. You pay only when revenue is recovered.

↳ Or email us directly at hello@veldarion.com

HIPAA-aligned SOC 2 Type II No long-term contract