Batch claim status
Pull claims from Waystar, Availity, BCBS or another payer platform and return status, denial reason and next action.
Automations we build
A sample of the work we take off billing and front desk teams. Every one is built around the systems you already use.
Claims and follow-up
Claim follow-up calls
Call the payer, get through the IVR, wait on hold, and return the rep name, reference number, outcome and next step.
Denial intake
Pull denials from ERAs, EOBs, clearinghouses and payer portals into one structured worklist.
Denial routing
Decide whether a denial needs a corrected claim, records, reconsideration, an appeal, auth follow-up or a person.
Clearinghouse rejection repair
Find the rejected field, prepare the fix and queue the claim for resubmission.
Corrected claims
Prepare corrected claims with the original claim number, frequency code and updated information.
Appeal deadline monitoring
Calculate filing deadlines and flag the claims that need attention now.
Daily follow-up report
Summarize submissions, payer responses, upcoming deadlines and claims that need a person.
Appeals and disputes
Claim disputes
Prepare the dispute, attach supporting documents, submit it to the payer and keep the confirmation.
Appeal letters
Write a claim-specific appeal from the denial, EOB, eligibility response, clinical records and payer rules.
Appeal packets
Put the letter, claim form, EOB, records, authorization and evidence together in the order the payer wants.
Appeal submission
Submit appeals through the payer portal, fax or mail and keep proof of submission.
Appeal follow-up calls
Confirm receipt, check status and find out what is missing or what comes next.
Timely filing proof
Collect clearinghouse reports, payer acknowledgments, submission history and letters into one proof-of-timely-filing packet.
Underpayment disputes
Compare payment to expected reimbursement and build the evidence for an underpayment dispute.
Eligibility and authorizations
Eligibility verification
Return active coverage, payer, plan, effective dates, subscriber details and coordination of benefits.
Insurance mismatch detection
Compare eligibility results with the EHR or PM system and flag the wrong payer, member ID, group, subscriber or coverage order.
Authorization retrieval
Search the EHR and payer portal for the authorization numbers and approval documents a claim needs.
Missing document collection
Spot a missing note, order, referral, signature or authorization and request it from the right person.
EOBs, payments and reconciliation
EOB redaction
Pull the right patient's pages from a multi-patient EOB and redact all unrelated PHI.
EOB and ERA posting
Extract payment data from EOBs and ERAs and prepare or post it into the billing system.
Payment reconciliation
Match payments to claims and flag missing, partial, duplicate or inconsistent payments.
Submission receipt matching
Match fax receipts, portal confirmations and mail tracking numbers to the right patient and claim.
Payer portals and correspondence
Payer portal submission
Fill out portal forms, upload documents, submit the request and capture the confirmation number.
Payer portal monitoring
Watch payer portals for new letters, records requests, appeal decisions and requests for more information.
Payer letter processing
Pull decisions, deadlines, requested documents, contacts and next actions out of payer letters.
Fax inbox processing
Read incoming payer faxes, identify the patient and claim, pull out the requested action and route it.
Documents and admin
Records request fulfillment
Pull the right records, assemble the packet, submit it and keep proof of delivery.
Payer form prefilling
Prefill dispute forms, reconsideration forms, cover sheets, API-40 forms and other payer documents.
Document filing
Rename and organize records, EOBs, appeal letters and payer responses and file them with the right patient or claim.
Fax and mail
One-click faxing
Send appeals, disputes and records packets to the right fax number and keep the delivery receipt.
One-click mailing
Print and mail appeals, disputes or records packets and return the mailing date and tracking number.
Show us the work you want to stop doing.
Bring a workflow, a spreadsheet, or an idea. We'll work through what Kepler can build and what a first pilot would cover.