Denial Shield by Araphos Health
Fix what's denied. Prevent what's next.
Denial Shield reads the remittance files your payers already send, explains each denial in plain English, and prepares the fix for a person to approve. Then it shows you which denials keep coming back, and why.
Early product. We are looking for a few billing teams to shape it with us.
CO-27 · N30The payer says coverage ended before the date of service.
Check eligibility for that date. If the patient has new coverage, bill the new plan. If coverage was active, appeal with proof.
Denials get worked one at a time. The cause stays where it was.
A denial arrives as codes on a remittance. Someone has to work out what the codes mean for this claim, decide between a corrected claim and an appeal, and do it before the deadline. Next week the same patient is denied for the same reason.
Denials sit
The worklist is longer than the day. Low-dollar denials wait, and waiting turns some of them into write-offs.
Deadlines slip
Every payer has its own appeal window. Nothing on the remittance tells you how many days are left on each one.
The same denials repeat
A wrong member ID denies every weekly visit until someone notices. Working each denial does not fix the registration behind it.
Why claims are denied even after an eligibility check
- The check was never run: a walk-in, or a busy morning.
- Coverage changed after the check, part-way through treatment.
- The wrong payer was chosen: UMR instead of UnitedHealthcare, or traditional Medicare for a patient on a Medicare Advantage plan.
- The subscriber's date of birth was entered for a dependent, or the other way round.
- The response said prior authorization was needed, or that another plan pays first, and nobody saw it.
- The details were retyped after the check, and a digit moved.
Work, learn, prevent
It starts with a file you already have: the 835 remittance from your payer or clearinghouse. Nothing to install, and no change to how you submit claims.
Work
In the product today
Read the remittance. Explain each denial in plain English. Prepare the fix.
Learn
In the product today
Group denials by root cause. Show which ones keep coming back, and the dollars behind them.
Prevent
Planned
Check coverage and registration details before the claim goes out.
Work: one list, in plain English
Denial Shield pulls the real denials out of the remittance, leaving routine write-offs and patient balances aside. Each one shows the patient, the payer, the reason in words, the dollars at risk and the days left.
- Fix it for me. Where the payer returned the right value, such as the member ID it has on file, you see it beside what was on the claim, with the changes a corrected claim needs. Where the denial calls for an appeal, the letter is drafted from the claim's facts. A person reviews and approves either one.
- I'll fix it manually. A short checklist for that kind of denial, a note, and a record of who worked it.
Learn: why it keeps happening
The same files show the pattern behind the denials.
- Denials grouped by root cause: eligibility, registration, wrong payer, prior authorization, coding and timely filing, with counts and dollars.
- Repeats: the same patient denied again for the same reason, by payer, by cause and by location.
- A short list of what to change at intake, in order of the dollars behind each cause.
Prevent: what comes next
Checking coverage and registration details before the claim goes out. This is planned. It is not in the product today.
What it does not do
- It does not submit claims or send appeals. You make the fix in your billing system. Denial Shield prepares it and keeps the record.
- It does not replace your practice management system or your clearinghouse.
- It reads denials. It does not see claims rejected before they reach the payer.
Built for the people who work the denials
Billing and RCM companies
You work denials for several practices, often in a different system for each client. Every one of those systems can produce an 835, so the denials can sit in one list, and you can show each client where its denials come from.
Multi-site behavioral health and substance use treatment practices
Weekly visits mean one registration mistake repeats on every claim. A billing manager needs to see which location and which cause are behind the denials, without building the report by hand.
"Our billing system already has denial tools"
It does, and it does a lot well
Your practice management system is the system of record. It schedules, registers, submits the claim and posts the payment. It scrubs claims before they go out, runs eligibility, and has a denial worklist you already pay for.
If that worklist is worked every day, denials are low, and nothing is written off for lack of time, you may not need us. We will tell you so.
Where Denial Shield fits beside it
- It says what a denial means and what to do next, in words a new biller can act on.
- It connects a denial back to its cause, and tells you when it is a repeat.
- It drafts the appeal, so the work starts from a letter and not a blank page.
- For billing companies, it is one worklist across every client's system.
We have not used every billing system. On a call, we will ask you to show us how you work a denial today.
Help decide what gets built
Denial Shield is early. We are looking for a few teams who will look at it, tell us where it is wrong, and help choose what comes next.
What you get
- Early access to the product as it is built.
- A direct say in the roadmap. You talk to the person building it.
- Founding-partner terms when Denial Shield becomes a paid product.
What we ask
- A few short feedback calls.
- Plain answers about what would and would not help your team.
- No patient information until a business associate agreement is signed.
Ask to take part
Rather talk first? Book a 20-minute conversation.
Araphos Health
Araphos comes from the Greek ἄραφος, "seamless": made in one piece, with no seam to come apart. It is what a claim should be, from registration to payment.
Araphos Health was founded by Joe Zayas in Rochester, Minnesota. Joe has spent his career in healthcare and claims technology, including claims administration software for health plans.
Much of that work was testing: finding where a claim breaks before a patient or a payer does. Denial Shield is the same habit, pointed at denials.
Careful with patient information from the start
A signed agreement first
We sign a business associate agreement before any patient information is handled. Until then, everything you see runs on made-up data.
Designed with HIPAA in mind
Each organization's data is kept separate from every other's, and actions on a denial are recorded with who took them. The product is being built to meet HIPAA's requirements.
What we will not claim
Araphos Health is a young company and holds no security certifications yet. When that changes, this page will say exactly which ones.