From Claim Dispute to Resolution

Most revenue recovery fails at the handoff between data and action. We’ve engineered every step of that handoff.

Steps

1. Ingest & Analyze

The workflow begins with structured data ingestion. Our AI-powered platform reads and analyzes denial letters, medical records, audit correspondence, and payer documentation using large language models—extracting the clinical and contractual details needed to build an accurate picture of each account. Document types that took hours to manually process are analyzed in minutes, with 99.7% accuracy in clinical fact extraction.

2. Price & Validate

Once ingested, each claim is priced against the actual terms of the payer contract. Accurate reimbursement calculation often requires pulling from multiple sources simultaneously—claim data, Medicare fee schedules, payer-specific contract terms, and other pricing inputs. ContractIQ weaves these together to produce a defensible, expected reimbursement figure, surfacing underpayments before they’re written off.

3. Compare & Correlate

The platform compares documentation against a curated, continuously updated knowledge base—including medical coding requirements, payer-specific contracts, and regulatory policy. This comparison identifies payment gaps, underpayment opportunities, and the strongest basis for dispute or appeal. The breadth of this knowledge base, built and maintained across hundreds of payers, is a core differentiator.

4. Craft & Review

The platform extracts relevant clinical evidence from the medical record and uses it to construct a targeted appeal or negotiation submission. Each output is reviewed and validated by clinicians and attorneys before it moves forward, keeping human judgment in the loop. AI handles the volume and extraction; specialists apply the expertise that converts evidence into recoverable revenue.

5. Appeal & Recover

Appeals are submitted according to precise payer guidelines—whether through standard appeals, out-of-network negotiations, or Independent Dispute Resolution filings. The platform tracks status and manages follow-through to resolution. Aspirion clients have seen meaningful improvements over traditional manual workflows—including 2.2x faster first appeals, 20%+ higher success rates, and reductions in time to cash by 20 days.

6. Report & Improve

Recovery doesn’t end at resolution. Infinia ML delivers ongoing reporting on clinical documentation trends, denial patterns, and underpayment drivers—giving health systems the visibility to address root causes upstream. Every claim worked becomes intelligence that strengthens future documentation, reduces denials before they happen, and builds performance over time.