Real payer intake
Sirrus ingests remits, ERA / 835 signals, portal denial notices, UM determinations, claim-status responses, and correspondence without waiting for an analyst to re-key the case.
Demo mode • boardroom-ready walkthrough
Sirrus runs the denial from payer intake to recovered cash.
Most appeal teams lose time in two places: finding the right facts across fragmented systems, and turning those facts into a consistent, defensible letter that can move a payer to reprocess the claim. Sirrus RCM AI is built to solve both — and then automate the rest.
The platform ingests payer denials, picks the right operating motion, assembles the exact evidence bundle, generates the motion package, submits it through the right payer channel, performs the portal and phone follow-up over the life of the claim, and confirms recovery on the remittance. On standardizable denials, it replaces the analyst and collection motion completely. Humans only enter when Sirrus flags an exception.
835 / ERA + portal intakeAnalyst-free on standardizable denialsCalls, status work, and follow-up automatedHumans only on flagged exceptions
What it replacesAnalyst and collector motion on standardizable denials
No manual triage, packet building, status chasing, or “call again next week” work.
What it usesSource records, contracts, policy, auth, and claim history
Every action is grounded in the actual case, not a generic denial template.
When humans enterOnly when Sirrus flags a real exception
Missing evidence, unusual clinical review, peer-to-peer, or contract conflict.
01Payer intake
02Case object
03Operating motion
04Payer ops
05Recovered cash
Live payer intake
Multiple denial artifacts, one grounded case
- 835 / ERA denial signal received
- Portal notice parsed and attached
- Authorization trace aligned to episode
- Claim and source records linked automatically
Sirrus operating layer
Not a letter writer — an autonomous denial engine
Denial classMedical necessity
MotionReconsideration
EvidenceComplete
Human handoffNot required
Autonomous case path
Released, followed, overturned, and posted
Appeal packet released
Portal and call follow-up running
Reprocess approved
Payment confirmation monitored
Why this lands with health systems
This is not “AI for appeal letters.” It is denial operations automation.
The letter is just one illustration of the product. The value is that Sirrus owns the denial through intake, strategy, evidence assembly, release, follow-up, overturn, and payment confirmation with no human intervention except flagged cases.
What Sirrus automates
The denial work that usually burns analyst hours disappears into software.
Built for revenue cycle leaders who care about the whole operating motion: intake, correct routing, evidence assembly, payer execution, persistence over long review windows, and actual cash recovery.
Correct motion selection
The system selects the right operating motion for the denial: corrected claim, reconsideration, formal appeal, re-open, prior-auth resubmission, peer-to-peer escalation, or contract variance dispute.
Source-grounded fact assembly
Orders, clinical notes, treatment plans, auth traces, claim history, contract terms, fee schedules, EOB / PRA copies, and submission proofs are bundled into a single grounded case object.
Payer-ready release
Sirrus generates the full motion package, compiles the attachment set, gates for completeness, and releases through the right payer channel without manual queue work.
Long-cycle follow-up
The software runs portal checks, call work, resubmissions, medical review follow-up, and timing-based nudges over weeks — not just a one-time letter drop.
Recovery confirmation
Sirrus closes the loop by detecting reprocessing, reconciling the recovery against the original balance at risk, and documenting the full audit trail.
How it works
A complete denial-to-overturn workflow, not a drafting tool.
Every step below is designed to present Sirrus as the autonomous operating layer: it ingests, proves, executes, follows up, and closes the denial rather than stopping after a document is generated.
01
Ingest denial signals
Normalize 835 codes, remits, portal notices, UM decisions, and claim history into one case object tied to the actual account.
02
Score recoverability
Rank the denial by expected recoverability, balance at risk, filing clock, and payer behavior so the right accounts move first.
03
Select the operating motion
Choose reconsideration, appeal, corrected claim, reopen, auth resubmission, peer-to-peer, or contract dispute based on the denial class.
04
Assemble the facts
Collect the exact evidence bundle: claim lines, dates of service, authorization proof, clinical documentation, contract language, and payer instructions.
05
Execute the appeal
Generate the payer-ready package, attach the support set, release it through portal / fax / mail workflows, and retain proof of submission.
06
Run the case through overturn
Perform spaced status checks, call work, supplemental releases, and payment confirmation until the denial is reversed or escalated as flagged.
AI appeal workspace
Motion
Detailed rad onc reconsideration specimen with dates, contract logic, and attachments
Grounded by source recordsPortal + remit intakeNo manual status chasing
Illustrative specimenDetailed provider-side rad onc reconsideration with dates of service, claim identifiers, policy logic, and contract/process crosswalk.
Sirrus-generated motion package
Medical necessity reconsideration / appeal
Re: Reconsideration of medical necessity denial for intensity-modulated radiation therapy (IMRT) services associated with the above claim.
Sirrus submits this motion on behalf of the treating provider and requests immediate reversal of the denial and full claim reprocessing. This package includes the denial artifact, supporting clinical records, claim and authorization timeline, and the routing logic used to select this reconsideration path.
Request for full overturn
Sirrus requests immediate reversal of the medical necessity denial and reprocessing of the above claim. This motion is grounded in the source clinical record, claim history, authorization trace, payer denial notice, and the applicable provider-appeal and IMRT policy framework mapped to this case.
Clinical and claim summary
The denied account reflects definitive radiation treatment for oropharyngeal squamous cell carcinoma with bilateral neck coverage. The record contains the radiation oncology consult, physician order, simulation note, inverse-planned IMRT treatment plan, dose-volume histogram set, and the signed course prescription showing total dose and dose per fraction across the treatment dates listed above. The claim history, billed units, and dates of service reconcile to the treatment course; no duplicate, bundling, or timing variance was identified.
Why the denial is incorrect
First, the payer medical-policy crosswalk for this demo shows head and neck cancers, including treatment involving the oropharynx, as a covered IMRT indication for definitive therapy when medically necessary. Second, the attached clinical record documents the exact elements payers and Medicare contractors expect to see in an IMRT review: diagnosis, target volume, total dose, dose per fraction, treatment-planning method, and a narrative statement describing why IMRT is required instead of conventional or 3D radiation therapy. Third, the comparative planning evidence in the packet supports the need to spare adjacent normal tissue and organs at risk while maintaining target coverage. Fourth, the authorization and claim timeline match the treatment episode, so the denial cannot be sustained on the basis of episode mismatch or unsupported dates of service.
Contract and process crosswalk
This specimen also includes an illustrative provider-agreement and administrative-guide crosswalk. Sirrus mapped the case to the payer’s reconsideration channel, populated the claim identifiers, dates of service, billed amount, and reason for disagreement, and attached the denial / EOB copy and supporting records before release. In production, the contract section would be bound to the live payer agreement, state-specific administrative guide, and plan-specific instructions attached to the account.
Requested relief
Please overturn the denial in full, reprocess the claim consistent with the submitted records, and issue corrected payment for the denied IMRT planning and delivery services. If the reviewer believes any additional clinical or administrative documentation is required, Sirrus routes that request automatically and releases the supplemental packet without restarting the entire motion.
Attachment set released with this motion
What a revenue cycle leader notices
The details that separate a flashy AI demo from a system you would actually deploy.
This build intentionally leans into the operational details revenue cycle teams care about: the right motion type, filing clocks, payer artifact integrity, release completeness, long-cycle follow-up, and confirmation that the recovery actually landed.
Denial intake is artifact-first
The software starts with real denial artifacts — ERA / 835, portal notices, UM decisions, EOB / PRA language, and claim history — instead of a manual work-queue abstraction.
It selects the right motion, not just a letter template
Strong denial automation knows when the answer is a corrected claim, reconsideration, formal appeal, reopen, or auth fix. A generic “write a letter” tool is not enough.
Clinical denials need record logic
For radiation oncology, the system has to understand diagnosis, target volume, treatment plan type, dose / fractionation, auth history, and the payer policy language that governs the review.
Completeness control matters
A missing EOB copy, missing plan comparison, or wrong denial attachment can cost weeks. Sirrus gates release so incomplete packets do not go out.
Follow-up is a calendar problem
Claims often take weeks and multiple inquiries to move. The call log here is intentionally spaced because that is what real denial management looks like.
Recovery is not real until cash lands
Portal “approved” is not the same as reprocessed cash. Sirrus keeps the case alive until the recovery posts and reconciles to the original balance at risk.
Deployment surface
Where Sirrus plugs in
- Patient accounting / billing system
- Clearinghouse and ERA / 835 intake
- Payer portals and claim-status feeds
- Authorization platform and UM artifacts
- EMR / clinical source documents
- Contract, provider-guide, and fee-schedule repository
Controls
How leadership keeps control while software does the work
- Exception routing on low-confidence or unusual cases
- Immutable audit trail of every submission, call, and status update
- Case-level evidence lineage back to source record IDs
- Release thresholds by balance at risk, payer, denial class, or service line
Final positioning