Missed Deadlines
Insurance appeals are strictly time-boxed. Without automated tracking, practices routinely forfeit their right to appeal — and the revenue that comes with it.
Hundreds of millions of valid claims are denied every year. ClaimApproved.ai is the secure, AI-powered platform that enables specialty clinics and patients to execute appeals efficiently, correctly, and at scale.
The Problem
Providers lack time and visibility. Patients can't self-execute without clinical authority. And no one has the infrastructure to fight systematically at scale.
Insurance appeals are strictly time-boxed. Without automated tracking, practices routinely forfeit their right to appeal — and the revenue that comes with it.
Physicians spend hours on medical necessity letters that are missing the exact clinical evidence and statutory citations payers require — causing avoidable secondary denials.
Patients, providers, and billing staff operate in silos. No shared case view, no handoff tracking, no outcome data. Coordination failures kill winnable appeals.
Specialty clinics have no way to measure what denials cost them or what successful appeals recover. Without data, the problem stays invisible — and unfunded.
Platform Status
This is not a concept. The codebase is live — React frontend, .NET 9 backend, gRPC-Web API, PostgreSQL, and full CI/CD. Seven major milestones are complete.
Client-side AI inference via WebLLM running in-browser. AES-256 encryption via WebCrypto before any upload. PHI never leaves the patient's device for AI processing.
Auth0 JWT validation on all endpoints. Role-based access across patient, provider, clinic admin, and platform admin. Full org-scoped data isolation.
Background worker evaluating deadlines continuously. Multi-threshold escalation at 7-day, 3-day, and 1-day windows with in-app and email delivery.
Fax and certified mail submission methods with background processing, exponential backoff retry, and immutable submission records with confirmation IDs.
6-stage case intake: Upload → Local AI Analysis → Review → Encrypt → Submit. Provider attestation, case detail views, document management, submission history.
Full gRPC-Web API with proto-defined contracts. State machine from intake through L1/L2 appeal to resolution. PostgreSQL, Docker Compose, GitHub Actions CI/CD.
The Technical Moat
Our privacy-first design isn't a feature — it's a foundational differentiator that accelerates HIPAA compliance, eliminates our liability as a data custodian, and is the reason health systems will trust us with their most sensitive workflows.
A local language model runs directly in the browser via WebGPU. Your denial letter is analyzed without ever touching an external AI API — no data leaves the patient's device for inference.
Documents are encrypted before upload. We store encrypted blobs — meaningless ciphertext. The server is a zero-knowledge storage conduit. We cannot be compelled to produce PHI we don't hold.
Our backend drives the entire appeal workflow — deadlines, stages, escalations — from de-identified metadata. Mapped to all 18 HIPAA Safe Harbor identifiers. Compliance documentation is written and ready.
Go-to-Market
Specialty clinics in oncology, rare disease, and specialty pharmacy face the highest denial volumes and the most complex cases — and are the most underserved by existing tools.
Route 1
Founder-led sales to oncology, rare disease, and specialty pharmacy practices. The goal is 3–5 design partners to validate the workflow, prove ROI, and establish the case studies that open enterprise doors.
Route 2
Partner with nonprofit patient advocacy organizations — disease-specific foundations with established patient communities. Co-marketing and subsidized access as a demand-generation engine alongside the clinic track.
Route 3 · Scale Lever
License the platform to Revenue Cycle Management companies who white-label for their clinic customers. RCM firms already have relationships with hundreds of clinics — bypassing direct sales entirely.
Let's Talk
We're moving fast and we'd love to bring the right partners along. Reach out to start a conversation with the founders.