A managed digital employee for one queue
Denials your practice writes off because nobody has time to appeal them, appealed.
Send us the denial and the chart excerpt. We prepare the appeal packet: the denial reason mapped to the payer's own policy, the evidence listed, the letter drafted, the missing pieces named. Your clinician approves, corrects or rejects it in minutes. Every item goes on a sealed record you can verify without trusting us.
$2,500 a month with 400 items included, or start with a $499 written design of your queue, credited against the first month.
The problem, in other people's numbers
of physician and staff time on them, per physician, per week
AMA 2025 physician survey, May 2026
Most denials are never appealed, and most appeals win. The gap is time: the authorization desk is already full. That gap is what we fill.
How it works
Four steps. Your reviewer holds the pen on every one.
One denial, five steps
Follow one denial through the service.
Every fact below is pulled from one pilot's own record, at /example/ledger.json: made-up practice and denials; the record and verifier are real.
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1. The denial arrives
Example Health Plan (fictional). MRI lumbar spine without contrast, CPT 72148. Denied 2026-09-02. Reason given: "Documentation does not establish six weeks of conservative therapy prior to advanced imaging (policy…
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2. The packet is prepared
Mapped to the payer's policy: "IMG-104 section 2(b): six weeks of documented conservative therapy including physical therapy or a home exercise program, and a trial of anti-inflammatory medication, before lumbar MRI in the absence of red flags."
The letter drafted for the reviewer opens: "Dear Appeals Reviewer, we request reconsideration of the denial dated 2026-09-02 for lumbar MRI (72148). The record documents eight weeks of physical therapy and a six-week course of naproxen, which exceeds the six…"
Evidence listed: PT progress notes 2026-06-15, 2026-07-08, 2026-08-10 (14 visits documented), Medication list showing naproxen course 2026-06-15 to 2026-07-30, Office note 2026-08-24: radicular pain persists after conservative care.
Still missing: Physical therapy discharge summary (requested from the PT clinic; owner: front desk).
Next to act: Biller to attach the PT discharge summary before submission.
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3. The reviewer writes a correction
Dr Example (fictional reviewer) on item 1: "Quote the policy criterion word for word and give the date of every note you rely on."
That correction is now a rule. No later item can enter the record without citing it.
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4. The next packet cites the rule and is approved
Item 2 cites the rule written after item 1: "Quote the policy criterion word for word and give the date of every note you rely on."
Decision: approved by Dr Example (fictional reviewer).
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5. The record is sealed
Head: event 6, hash
a47ef9cbb97be274…, signed with key3bdb547d2019.
Step 1 of 5
The record
Every decision is sealed, and you can check it without asking us.
Each item, each decision and each correction is one event in a chain. Each event's fingerprint covers its content and the event before it. After every event the head of the chain is signed with a key whose public half is published. Export your record and run this from any machine:
curl -s 'https://strategic-innovations.ai/v1/pilots/YOUR_PILOT/ledger?key=YOUR_KEY' \ | curl -s -X POST -H 'content-type: application/json' --data-binary @- https://strategic-innovations.ai/v1/ledger/verify
It answers "ok": true only if every fingerprint matches, the signature verifies against the public key, and the count of completed items is the count in the chain. Change one character of the export and it answers "ok": false with the reason. Auditors, payers and partners can run the same command. See a worked example: two made-up denials, one correction, the real record underneath.
What it costs
Three ways to buy. The prices are on this page on purpose.
- A written design of your queue within five working days of payment: the queue, its owner, the approval gate, the exception path, baseline volume, the scorecard the pilot is judged on.
- Paid on Stripe. Reply to the receipt to book the 30-minute scoping call.
- One queue, one reviewer on your side, a person on ours.
- 400 completed items included, then $6 an item, invoiced monthly from the record.
- Rejected items are recorded and never charged.
- The reviewer console, the sealed record and the verifier, included.
- Priced per completed item by queue, with security review, procurement terms and multi-tenant controls.
- For groups with volume, vendor review or legal terms to settle before launch.
Want to run the workspace yourself? Free, $49 and $149 plans are on the pricing page.
Built to the rules a practice already lives by
It fits the way your office works today. Nothing changes except the backlog.
- Your people keep the portal. The packet arrives ready; someone on your team submits it the way they do now. No new logins, no new access to grant.
- Your reviewer signs every one. Each packet carries an approval recorded in your console before it goes anywhere. The record names the reviewer, the decision and the time.
- Patient data moves under your BAA. The design names the sources before the first item; the agreement is signed before the first packet.
- Your results are yours to publish. Every number on this page links to who measured it and when. Your scorecard comes from your own sealed record, and the first three practices set the price for everyone after them.
Who it is for
Independent specialty practices, DME and home-health operators.
The buyer is usually the revenue cycle director or the practice administrator: the person who sees the denial report, carries the authorization staff on the payroll, and can sign a $2,500 monthly agreement without a committee. If that is you, the design fee is the fastest way to find out whether this works on your queue.