Autonomous denial management

Denied today. Paid without touching it.

Sirrus takes a denied claim from payer intake to recovered cash with no human intervention. It ingests the denial, selects the right motion, assembles the evidence bundle, executes the submission, runs follow-up over weeks, and closes only when payment posts on the remit.

On standardizable denials, it replaces the analyst and collector completely. Humans only enter when Sirrus flags a real exception — missing evidence, clinical conflict, or a contract dispute that requires legal review.

835 CARC / RARC parsing and denial routingAnalyst-free on standardizable denialsAutomated follow-up through the full review cycleHuman escalation only on flagged exceptions

See a live denial worked end to end How it works

01Intake

02Classify

03Assemble

04Execute

05Follow-up

06Recover

$84,600 recovered · 0 human touches · 23 days to close

0%First-level reconsideration overturn rate

$0.0MAvg monthly net recovery per client

ZeroHuman touches on standardizable denials

0 daysAvg days from denial to posted payment

How it works

The autonomous loop: intake, execute, recover.

Sirrus owns the denial from payer signal to cash confirmation. No analyst queue, no manual packet-building, no status chasing. The platform handles the full operating motion and escalates only true exceptions.

Ingest and classify

Sirrus reads 835 remittance data, CARC / RARC codes, portal notices, and UM decisions — normalizes them into a structured case object, and selects the right operating motion without an analyst.

Assemble and execute

The platform pulls the exact evidence bundle, generates a payer-ready package, gates for completeness, and submits through the right channel with proof of submission retained.

Follow up and recover

Spaced status checks, call work, and supplemental releases run over the full review window. The case closes only when reprocess and payment are confirmed on the remittance.

Real payer intake

Sirrus ingests 835 remittance data with CARC / RARC codes, portal denial notices, UM determinations, and claim-status responses without waiting for an analyst to re-key the case.

Source-grounded fact assembly

Orders, clinical notes, auth traces, claim history, contract terms, and EOB copies are bundled into a single grounded case object — no manual packet-building.

Recovery confirmation

Sirrus closes the loop by detecting reprocessing on the remit, reconciling the recovery against the original balance at risk, and documenting the full audit trail.

Live demo case

Medical necessity denial worked autonomously from intake to recovered cash.

This case is built like a real provider-side denial motion. Sirrus does not just generate a letter — it constructs the full case, maps policy and contract logic, submits the motion, follows the payer through the review cycle, and closes only when payment lands.

Balance at risk$84,600

Service lineRadiation oncology

Case typeMedical necessity denial

Primary diagnosisOropharyngeal squamous cell carcinoma (C10.9)

Dates of service01/27/2026 – 03/11/2026

Denied servicesIMRT treatment planning (CPT 77301) + definitive IMRT delivery (CPT 77385 × 33)

Denial codesCARC 50 · RARC MA01 (medical necessity not established; first-level appeal rights preserved)

Denial received04/02/2026

Primary evidence setRO consult, physician order, simulation note, inverse plan, DVH, dose / fraction schedule, auth trace, claim timeline

Autonomous pathReconsideration motion, attachment release, portal submission, call work, medical-review follow-up, reprocess confirmation

Human only if flagged

Missing or conflicting authorization evidence across systems
Low-confidence clinical rationale after policy and plan comparison
Peer-to-peer request or atypical medical-director escalation
Contract language conflict that requires payer-specific legal review
Attachment completeness failure before release

What Sirrus found that helped overturn

The payer denial carried CARC 50, but the clinical record satisfied every element the payer policy lists as required for IMRT coverage of a head-and-neck indication — making the denial procedurally unsustainable.
The authorization trace covered the same episode and treatment dates, eliminating the risk that this was an authorization mismatch disguised as a clinical denial.
The inverse plan and DVH package documented organs-at-risk sparing that a conventional or 3D technique could not achieve at the prescribed dose and fractionation — directly addressing the standard IMRT medical necessity threshold.
Claim lines, units, CPT codes, and dates of service reconciled to the treatment course with no duplicate, bundling, or billing-variance issues identified before release.

AI appeal workspace

Intake

Case facts, source records, policy match, and autonomous release gate

Grounded by source recordsPortal + remit intakeNo manual status chasing

Grounded case facts

Sirrus turns the denial into a structured case with the exact records needed to support overturn.

Medical necessity denial parsed from the 835 remittance (CARC 50 / RARC MA01) and linked to the correct IMRT claim, account, and episode of care.
Oropharynx and bilateral neck target volumes mapped to the treatment plan, with total dose and dose per fraction aligned to the course summary.
Inverse-planned IMRT, dose-volume histogram evidence, and narrative rationale for IMRT versus conventional technique assembled into the appeal bundle.
Authorization history, claim timeline, and submission history reconciled to the same dates of service before the motion was released.
Completeness gate confirmed: denial notice, EOB copy, comparative planning artifacts, and payer-specific appeal instructions all present before submission.

Policy / contract match

Clinical policy matchHead and neck / oropharynx fits payer IMRT coverage criteria for definitive treatment — no coverage exclusion applies.

Documentation matchDiagnosis (ICD-10 C10.9), target volume, total dose, dose per fraction, inverse planning method, and narrative rationale all attached.

Contract / process matchFirst-level reconsideration path triggered with claim identifiers, DOS, billed amount, denial copy, and supporting records per provider agreement.

Release gateMotion held until attachment set was complete and timely-filing clock was confirmed open. No partial submissions released.

Autonomous release gate

Claim identifiers completeMember ID, claim #, DOS, billed amount, denial artifact present.
Clinical packet completeOrder, consult, plan, supporting artifacts, and narrative rationale all attached.
Route selectedReconsideration path selected based on denial class and payer instructions.
Filing clock openSubmission released only after the platform confirmed the clock was still live.

Autonomous denial operations

Denied today. Paid without touching it.

Sirrus is the autonomous denial operating system — not a drafting tool or an add-on to an existing workflow. It owns the case from payer signal to posted cash.

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