On a share of collections, every denial your team skips is your fee, skipped too.
Nationally, about 65% of denied claims are never resubmitted (MGMA). Fighting one by hand runs $43.84–$57.23 of staff time (Premier) — more than the recovery is worth on most claims, so the pile sits. Every claim in it is revenue your client never sees, and a fee you never bill.
45–90 min to cite one appeal by hand· practitioner estimate
Of every 100 denied claims…
≈12appealed
Most denials are never worked. When providers do appeal, the majority are overturned — most were denied for reasons a cited appeal answers. That unworked pile is the opportunity.
Medicare Advantage prior-auth, 2024: 11.5% of denials appealed, 80.7% of those overturned (KFF).
$43.84–$57.23
staff cost to fight one denial by hand
Premier, 2022 / 2024 surveys
$9 to $5
a finished, cited letter — volume credits
plus your biller's review minutes
$48
your fee on one recovered $800 imaging claim, at a typical 6% of collections
worked example — your rate may differ
At $50 of staff time a claim, the backlog is unprofitable to touch. At $5–9 a letter, it becomes work worth doing — and that written-off pile is exactly where your unbilled fees sit.
Scale it to your book.
Set your practices and payer mix. The estimate runs against Merits' real volume pricing and the measured cost of fighting the same stack by hand.
Your book
In-network marketplace average, 2024. Your payer mix will differ.
Your operating choice — the denials worth a letter, not every denial.
Across the whole book
at $5 a letter50+ credits tier
staff time · Premier $43.84–$57.23/claim
volume-tier letters · plus review minutes
An estimate from your inputs. The hand-cost is Premier's measured range; the Merits cost is the published tier price for that volume. It doesn't count the collections fee you earn when the recovered claims pay — that's on top.
One desk, one login, credits per client.
Apply for partner access →Your whole book, kept straight — one line per client.
Patient-side tools serve one patient. Enterprise platforms want an implementation project. The Partner Account is built for the desk in between — the company billing for more than one practice.
Credits, per practice
Fund each client separately and bill the right one every time. Balances never blur between practices.
One team, every client
Your billers share a single login. Every appeal records who filed it, and for which client.
Client-by-client visibility
Open any client for its appeals, credits, and what's still in review. The spreadsheet retires.
You know before you spend
A denial that rarely wins is flagged up front, and a no-appeal claim never costs a credit.
Refer the practices you already talk to — and get paid while they stay.
You already speak with billers and practices every week. Refer them and earn a share of what they spend: 20% as a Partner, and 25% recurring for as long as a Preferred client stays active. Set your book below.
That's $1,200 a month in referred purchases across your book.
Partner20%
$240
per month
$2,880/yr
Preferred Partner25%
$300
per month
$3,600/yr
An estimate from your inputs, at the published tier rates — not a guarantee. Real earnings depend on what your referred clients actually buy. Partner commission runs 12 months per client; Preferred is recurring.
Tier one
Partner
20%
of what every client you refer spends.
- How you qualify
- From the moment your account is approved
- How long it lasts
- Recurring on every purchase they make, for 12 months
Top tier
Preferred Partner
25%
- How you qualify
- 5+ active referred clients, or $500+/mo in their purchases
- How long it lasts
- Recurring — for as long as the referred client stays active
Want the full economics? Read the field guide — Denials Are a Profit Line →
Two income lines, one account.
Apply for partner access →A monthly statement that answers “what did you do for my money?”
Export a per-practice statement of measured activity — never a recovered figure or a win rate we can't honestly source. It leads with the claims you didn't appeal, at no charge. Print to PDF or CSV.
Appeals activity statement
Generated Jul 1, 2026
Activity through Jul 1, 2026
For client practice
Willamette Valley Orthopaedics
Orthopaedic Surgery · OR · NPI 1093817465
Client since Mar 14, 2026
$10,750
Billed / disputed on worked claims
10
Appeals prepared
9
Ready to file
2
Reviewed — no appeal, no charge
“Billed / disputed” is the charge on each denial we worked — not an amount recovered or promised. “Ready to file” means the cited letter is prepared for your signature; it is not a filed or paid claim.
Claims we did not appeal — and why
No charge2 claims were reviewed and judged not worth appealing — a correct contractual write-off, patient responsibility, or duplicate. No credit was used, so you were not billed for them. Not chasing a losing appeal is part of the work.
- 06/19/2026#D4E7CO-45CPT 99214$180
- 06/06/2026#C3F2PR-1CPT 99213$95
Denials worked, by reason
| Denial reason | Claims worked | Billed / disputed |
|---|---|---|
| Medical necessity | 4 | $6,800 |
| Bundling / NCCI | 2 | $1,180 |
| Prior authorization | 2 | $1,910 |
| Timely filing | 1 | $640 |
| Underpayment | 1 | $220 |
| Total worked | 10 | $10,750 |
Appeal ledger
| Date | Ref | CPT | CARC | Billed | Argument | Status |
|---|---|---|---|---|---|---|
| 06/30/2026 | #F6C5 | 62323 | CO-50 | $560 | Medical necessity | In progress |
| 06/28/2026 | #A7F3 | 27447 | CO-50 | $3,120 | Medical necessity | Ready to file |
| 06/26/2026 | #B12C | 73721 | CO-197 | $980 | Prior authorization | Ready to file |
| 06/22/2026 | #C9A1 | 20610 | CO-97 | $410 | Bundling / NCCI | Ready to file |
| 06/19/2026 | #D4E7 | 99214 | CO-45 | $180 | — | No appeal |
| 06/17/2026 | #E5B8 | 64483 | CO-50 | $1,240 | Medical necessity | Ready to file |
| 06/14/2026 | #F6C9 | 29881 | CO-29 | $640 | Timely filing | Ready to file |
| 06/12/2026 | #A1D0 | 72148 | CO-197 | $930 | Prior authorization | Ready to file |
| 06/10/2026 | #B2E1 | 20936 | CO-4 | $770 | Bundling / NCCI | Ready to file |
| 06/06/2026 | #C3F2 | 99213 | PR-1 | $95 | — | No appeal |
| 06/04/2026 | #D4A3 | 27130 | CO-50 | $1,880 | Medical necessity | Ready to file |
| 06/02/2026 | #E5B4 | 76942 | CO-45 | $220 | Underpayment | Ready to file |
Sample statement — fictional practice, synthetic data.
Every line traces to a named source the reviewer can open.
The letter your biller hands over answers the denial with the payer's own policy and the governing rule, quoted verbatim — nothing paraphrased into existence. It never names Merits, and the provider signs and files it.
- The payer's own medical policy — 484 across 43 insurers
- Medicare LCDs & NCDs, for the exact code
- Published independent-review rulings on denials like it
- NCCI edits behind CO-97 / CO-4 bundling
- ERISA & ACA appeal law, captured verbatim
- FDA labels, device approvals, NEJM / JAMA trials
Set it up in a minute.
Tell us about your company and we'll create your organization right away. You sign in with a one-time link — no password to manage for you or your team.
- 1
Create your account
Apply below and open the magic link we email you.
- 2
Add your practices
Add each client — and your own company — then fund them with credits.
- 3
File appeals
Upload a denial, pick the client, and the letter is ready for the provider to sign.
You start with 3 welcome credits to allocate — enough to run your first appeals before you buy a thing.
What happens if an AI-drafted appeal letter is wrong?
A Merits letter cannot leave without the provider: unsupported claims become review flags that block the download, the provider attests and signs under their own name, and the letter never mentions Merits or AI. Denials Merits cannot honestly argue are refused, free.
Why add a per-letter cost if my staff already does appeals?
Fighting one denial by hand costs $43.84–$57.23 of staff time (Premier), which is why about 65% of denied claims are never resubmitted (MGMA). At $5–9 a letter, previously unprofitable appeals become worth working — and your collections fee on the recoveries is yours.
Is Merits safe for a HIPAA Business Associate to use?
Patient identity is stripped in the browser and restored on the biller's device at download; the uploaded EOB is deleted after generation; payment records and logs carry a case ID only. Nothing clinical rides through Stripe or email.
No card required to start. You only pay when you buy credits for a practice.