CoverageUnlocked Information

$262B in claims are denied every year (CMS). 75%+ are overturnable on appeal (KFF). Fewer than 2% ever get one filed. Most platforms react to denials. CoverageUnlocked reverse-engineers why payers deny, so the claim gets fixed before it goes out. When one slips through, the appeal carries a named pattern and the regulatory leverage to win. Big Ticket Blocker. Clinical Evidence Starvation. Ticking Clock. These are named payer behavior patterns from our graph — 24+ payers annotated with insider context built over 20 years inside the industry. None of it lives in public data. For health systems: $2–4M a year in recoverable revenue for 200–400 bed hospitals. Pre-submission scoring across 489 procedures, 24+ payers, 15 state regulatory environments. Under 60 seconds per claim. Works with Epic, Cerner, MEDITECH, and any EHR with a REST API. For RCM partners: a white-label API behind your denial management product. FHIR R4, batch processing for 1,000+ claims, multi-tenant with client-level isolation. We sell through partners, not around them. For pharma market access: drug-specific denial patterns, step therapy mapping, formulary positioning across 24+ payers and 15 states. 90-day brand pilots convert to annual contracts with a performance kicker on incremental revenue. Six intelligence systems: · Predictive Denial Analysis — payer medical director simulation · Payer Decision Graph — 24+ payers, behavioral annotations · Pre-Submission Scoring — five-factor weighted model · Agentic Appeal Pipeline — 5 AI agents: medical, regulatory, financial, timeline, quality · Temporal Intelligence — real-time payer behavior shifts · Regulatory Leverage Engine — 15 states, live enforcement data HIPAA-compliant. PHI sanitized before AI. 7-year audit logs. BAA ready. SOC 2 Type II audit in progress. 99.5% uptime SLA. Start with the CPT lookup at coverageunlocked.com/enterprise. No form. Or email ned@coverageunlocked.com for a free 200-claim analysis of your current denials.