Claims, denials & underpayments
Claims that get followed, not just filed
Submission isn't the finish line — it's where the case leaves your systems and enters the payer's. Perivanta keeps working it: tracking adjudication, chasing silence, appealing denials with the case's own evidence, and checking every remit against the contract.
Perivanta is in development with founding design partners — this page describes the capability we’re building together.
- 0355 · denied → appeal filed day 2, citing the auth on file
- 0348 · paid −9% → recovery packet filed against contract
- Root cause — a modifier rule — fixed upstream for good
After submission, the case goes quiet — and quiet is expensive
Once a claim goes out, most centers wait. Claims age silently, denials arrive weeks later to be worked one at a time by whoever has capacity, and appeals get rebuilt from scratch — hunting down the auth number, the op note, the eligibility check that all exist somewhere. Timely-filing and appeal windows keep running while the hunting happens.
Underpayments are quieter still. A rate paid a few percent light or a carve-out applied wrong just becomes the number in the ledger — most ASCs have no systematic remit-versus-contract check at all. Physician-owned centers, which make up most of the industry, rarely have the analytics back office that catching this requires.
What Perivanta does after the claim goes out
Perivanta holds the complete case record — eligibility, auth, documentation, codes, contract terms — so the follow-through work runs on evidence instead of archaeology.
Claim status monitoring
Tracks every claim through adjudication, chases the ones that go silent, and keeps timely-filing and appeal clocks visible before they expire.
Denial triage & appeal drafting
Classifies each denial by root cause and drafts the appeal from the case's own evidence — the auth on file, the op note, the eligibility check — ready for review and submission.
Underpayment detection
Checks every remit against your contracted rates, flags short payments and misapplied clauses, and packages the documentation recovery requires.
Root-cause feedback
Routes what payers deny back upstream — to intake, auth, and coding — so the same denial stops recurring instead of becoming a permanent appeal workload.
Payer behavior evidence
Accumulates payment behavior, denial patterns, and turnaround by payer over time — the evidence file your next contract conversation deserves.
Write-off discipline
Nothing gets written off by default. Every balance ends in an explicit decision by your team, with the history of what was tried attached.
Appeals prepared. Authority respected.
Appeals, waivers, and write-offs are consequential actions — they execute under the authority your center configures, whether that's review-and-approve or autopilot for routine categories with exceptions escalated.
Perivanta isn't a billing service or a contracting middleman. It works on top of your existing billing workflow — in-house or outsourced — and your payer relationships stay yours, now with the receipts attached.
Common questions
- Is Perivanta a billing or RCM service?
- No. Perivanta automates the follow-through around your existing billing workflow — monitoring, triage, appeal preparation, underpayment detection — whether claims are submitted in-house or by an RCM partner.
- Will it file appeals automatically?
- Only under the authority you configure. Most centers start with drafts prepared for review; routine, high-confidence categories can graduate to automatic filing with exceptions escalated. Consequential decisions like write-offs always stay with your team.
- What data does this require?
- Your payer contracts plus the claims and remittance history your billing process already produces. Because Perivanta also holds the upstream case record — eligibility, auth, documentation — appeals draw on evidence most billing tools never see.
- How do ASCs usually discover underpayments today?
- Mostly by accident: a biller notices a rate looks off, an audit samples a quarter, or a consultant reviews contracts during a sale. Systematic remit-level checking is rare outside large chains — it's exactly the kind of continuous, unglamorous work software should be doing.
Design partner program
Help build the system that does the work
We are selecting a small group of founding centers to shape the platform. Design partners get early access, direct input on the roadmap, and founding-partner terms.