Autonomous Denial Management

Overturn Improper Downgrades and Denials Automatically

Payers use automated algorithms to deny or downgrade 30% of valid claims. Elva fights back with equal force. It instantly reads denial codes (CARC/RARC), cross-references them with clinical evidence, and writes irrefutable, data-backed appeal letters that recover the revenue you’ve already earned.

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40%recovery rate

100%deadline compliance

Code Interpreter

Translates cryptic denial codes (like "CO-45" or "Missing Info") into plain English instructions for your team.

Auto-Appeal Writer

Generates professional appeal letters citing specific clinical findings (e.g., "50% bone loss") to reverse "Medical Necessity" denials.

Downgrade Defense

Identifies when a "Least Expensive Alternative Treatment" (LEAT) clause was applied and calculates if an appeal is viable.

Timely Filing Watchdog

Tracks the appeal window for every rejected claim, ensuring you never miss the deadline to fight for payment

THE "OLD WAY" VS. ELVA

The "Write-Off" vs. The "Fight Back"

The Old Way (Spreadsheet Purgatory): You get a stack of EOBs. You highlight the denials, put them in a folder, and plan to "get to them Friday." Friday never comes. You eventually write off thousands of dollars because you didn't have time to find the X-rays and write the letters. The Elva Way (Instant Rebuttal): Elva sees the denial the moment the ERA lands. It pulls the X-ray, highlights the pathology, drafts the appeal letter, and puts it in your "Ready to Send" queue. You recover revenue while you sleep.

ELVA CHAT INTEGRATION

Don't hunt through the mail. Just ask.

our team can ask Elva to analyze denial trends or specific cases instantly. Office Manager: "Why are we seeing so many denials for Night Guards lately?" @Elva: "Analysis: 8 out of 10 Night Guard claims this month were denied for 'Medical Necessity.' The payer (Delta) requires a photo showing wear facets, which was missing. Shall I add a 'Photo Required' rule to the Night Guard workflow?"

The "Rubber Stamp" Denial Ends Here

Insurers bet that you are too busy to appeal a $150 denial. Elva isn't. It systematically challenges every improper adjustment, turning "Write-Offs" back into "Revenue."

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The Automated Recovery Unit

Elva turns "Denials Management" from a chaotic pile of paper into a streamlined digital workflow.

Intelligence

ERA/EOB Autopsy

Elva reads the Electronic Remittance Advice (ERA) instantly. It doesn't just post the payments; it strips out the denials and sorts them by "Reason Code" (e.g., Eligibility vs. Documentation vs. Bundling), assigning them to the right team member.

Visibility

"At-Risk" Revenue Dashboard

Elva tracks every dollar sitting in "Denied" status. It ages them (30/60/90 days) and prioritizes the high-value claims (like Implants) so your team focuses on the biggest checks first.

Automation

Bulk Appeal Generation

Received 10 denials for the same reason (e.g., "Missing Tax ID")? Elva generates a batch of 10 correction letters instantly, fixing the administrative error and resubmitting them all with one click.

Learning

Root Cause Analytics

Elva learns from your denials. If you keep getting denied for "Missing Perio Charts," Elva updates its Pre-Submission Rules to force a Perio Chart attachment next time, stopping the cycle.

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The "Reversal" Logic Layer

Elva knows the specific clinical keywords that adjudicators are legally required to accept. It builds the argument for you.

Surgical Extraction (D7210)

The Denial: Payer downcoded D7210 to Simple Extraction (D7140), claiming "No proof of surgery". Elva's Appeal: Elva drafts a letter attaching the post-op photo of the sectioned tooth. The narrative states: "Procedure required elevation of mucoperiosteal flap and tooth sectioning. Evidence attached proves criteria for D7210 were met."

Core Buildup (D2950)

The Denial: Denied as "Inclusive to Crown". Elva's Appeal: Elva argues Retention. The letter cites the pre-op X-ray: "Remaining tooth structure was less than 50% after excavation. Buildup was medically necessary for retention of the prosthesis, not for blocking out undercuts.".

SRP (D4341)

The Denial: Denied for "Lack of Bone Loss". Elva's Appeal: Elva compiles the "Perfect Packet." It highlights the Bitewings showing bone levels and the Periodontal Chart showing 5mm+ pockets. The letter explicitly states: "Radiographic evidence of alveolar bone loss confirms diagnosis of Periodontitis, not Gingivitis.".

Crown Replacement (<5 Years)

The Denial: Denied because the previous crown is only 4 years old (5-year rule). Elva's Appeal: Elva argues Non-Serviceability. It attaches an X-ray showing recurrent decay or open margins. The narrative reads: "Existing prosthesis is non-serviceable and cannot be repaired. Clinical failure overrides frequency limitation.".

Posterior Composite (LEAT)

The Denial: Downgraded to Amalgam fee. Elva's Appeal: Elva checks the medical history. If an allergy exists, it writes: "Patient has documented metal allergy. Amalgam is contraindicated. Medical necessity dictates composite material. Please process at full allowable fee.”.

Missing Tooth Clause

The Denial: Bridge denied because "Tooth extracted prior to coverage". Elva's Appeal: Elva checks for Continuous Coverage. If the patient had a previous plan, it generates a "Certificate of Creditable Coverage" request. The letter argues: "Patient has maintained continuous coverage. No break in benefits occurred; therefore, pre-existing condition clause does not apply.".

TAKE THE NEXT STEP

Fight Every Wrongful Denial

Don't let insurance companies keep your money. Equip your team with the AI that fights every denial with clinical precision.

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