Know which denials to fight.
Before your team touches the queue.
Your billing team is spending 45 days chasing claims they were never going to win. Upload your denied EOBs. Get one verdict per cluster in 48 hours: Recoverable. Conditional. Not Recoverable.
After the verdict: You know which 30% is worth fighting and what to fix. Your team works the appeals. We stop you burning labor on the 70% that's already decided.
48 hours from upload
to verdict.
Every denied cluster gets a cross-verified verdict. When analysis flags a conflict — compounded vs. branded, formulary exclusion vs. documentation gap — Shield surfaces it before you file. One flag can save 45 days of wasted appeal labor on a $4,500 claim.
The report tells you exactly which 30% to fight, what each appeal needs, and which clusters to stop touching. Your billers get a prioritized action list. Your CMO gets the ROI.
When analysis flags
a conflict, that's
the intelligence.
Single-model AI is a liability on a $5,000 claim. Shield uses a multi-model consensus approach — when the verdict analysis produces conflicting findings, Shield flags the conflict so you investigate before you file. Not after 45 days.
The Forensic Diagnostic and Monthly Retainer both deliver white-label PDFs — no BillerBrain watermark. Send it under your brand. It reads as your denial intelligence work, because you ran it.
If you're billing clients $1,500–$3,000/month for RCM consulting, a $2,500 retainer that produces weekly white-label reports isn't an expense. It's a margin-expanding tool.
The answer was already in the batch. Nobody looked at the whole thing at once. Shield looks at the whole thing — across every drug class, every payer, every denial code — and tells you exactly where the money is before your team opens a single file.
One recovered $5,000 Ketamine cluster pays for 2 months of Shield. One recovered $4,800 Semaglutide cluster pays for the full-year subscription. Your CMO will ask what paid for it. The answer is a single appeal that would have been skipped.
The verdict changes everything
before your team touches the queue.
Most billing teams work the denial after 45 days of effort. Shield delivers the verdict in 48 hours — which clusters to fight, which to fix, and which to stop touching permanently.
ILLUSTRATIVE SCENARIOS — Built from real payer formulary policy language. Dollar amounts are representative. Actual AR varies by batch.
Four denial drivers. None of them clinical failures. All identified before the appeal was filed.
◐ CONDITIONAL — all fixableFormulary exclusion confirmed. Appeal stopped before it was filed. Branded pivot path delivered in the same report.
✕ NOT RECOVERABLE — pivot path attachedTwo documentation gaps identified. Exact fix attached. Recoverable.
◐ CONDITIONAL — recoverableFour steps.
48-hour turnaround.
No EMR integration. No API setup. No software to learn. You send a file. You get a verdict.
Upload your denied 835s or EOBs
Export your worst denial batch as CSV, PDF, or 835 EDI. Upload your raw EOBs. We handle the rest under a signed BAA. No accounts, no software install, no IT ticket.
Shield groups by drug, payer & code
GLP-1s. Ketamine. TRT. HRT. Peptides. Every denial cluster gets its own verdict track. Same drug + same code from two different payers gets two different analyses.
Multi-model consensus on every cluster
Every cluster gets a cross-verified verdict. When models agree, you act with confidence. When they flag a conflict, Shield surfaces it — so you verify before you waste appeal resources.
White-label PDF in 48 hours
Recoverable, Conditional, Not Recoverable — with the exact documentation gap, payer policy reference, and action step for each cluster. Present it under your brand.
Specialized intelligence for the
highest-risk telehealth denial patterns.
| Drug Class | Top Denial Codes | Denial Risk 2026 |
|---|---|---|
| GLP-1Ozempic, Mounjaro, Wegovy (Branded) | CO-50 CO-197 CO-272 | CRITICAL |
| KETKetamine / Esketamine | CO-50 CO-96 CO-22 | CRITICAL |
| TRTTestosterone (TRT) | CO-50 CO-96 CO-119 | HIGH |
| HRTEstradiol / HRT | CO-96 CO-50 | HIGH |
| PEPPeptides (BPC-157, B12, NAD+) | CO-50 CO-16 | MEDIUM |
| J3490Compounded GLP-1 | CO-257 CO-50 CO-16 | ⚠ SUNSET |
Each drug class carries payer-specific policy rules, documentation requirements, and appeal windows that change every 90 days. The brief surfaces what applies to your specific batch — not a generic checklist.
These six drug classes carry the highest denial risk in telehealth billing today. Each carries purpose-built intelligence in every analysis. Any other drug or service code in your denial batch runs through the same engine. If it's in your EOB, Shield analyzes it.
Start free.
Scale when it pays for itself.
One recovered cluster pays for months of Shield. Start with your 20 worst denials — free, no commitment, no login.
One-time diagnostic or monthly subscription — no lock-in, no software, no IT setup
- ✓ 20-claim Denial Intelligence Brief — full forensic depth, capped at first batch
- ✓ Recoverable / Conditional / Not Recoverable per cluster
- ✓ Root cause + top 3 action steps
- ✓ 48-hour PDF delivery
- ✓ No login · no software · no EMR
No card · no commitment · limited availability
- ✓ Deep forensic analysis on your top 100 denials
- ✓ Full cluster breakdown per drug class + payer
- ✓ Cross-verified consensus — conflicts surfaced before you act
- ✓ Exact documentation fix for each Conditional cluster
- ✓ Not Recoverable clusters flagged — stop wasting appeal hours
- ✓ White-label PDF — present as your own deliverable to clients
- ✓ 24-hour priority turnaround
- ✓ Weekly ERA batch processing
- ✓ Payer formulary change monitoring (payers update every 90 days)
- ✓ White-label Monday reports — send under your brand
- ✓ BAA included — HIPAA-compliant workflow
- ✓ Dedicated Slack or email channel
- ✓ Priority 24-hour turnaround
One recovered $5,000 Ketamine cluster = 2 months paid
What billing directors
ask before they start.
Do I need to send real patient data?
No. De-identify your 835s — remove patient names, DOBs, and member IDs. We still get everything needed to run the analysis. For agencies that prefer a formal process, we provide a HIPAA Business Associate Agreement before any upload. Zero PHI stored after processing.
Is this just AI making things up about my claims?
That's exactly why Shield uses a multi-model consensus approach instead of a single AI. When the models produce conflicting verdicts, Shield flags the conflict and tells you what to verify before acting. The disagreement is the intelligence — not a problem to hide.
We already have a billing team handling appeals.
Good. This is for them. Your senior biller should not spend 45 minutes manually researching every CARC/RARC combination. Shield gives them the root cause in 48 hours so they concentrate on claims that can actually be recovered — and stop before the ones that can't.
Can I present the Shield report to my clients?
Yes. The Forensic Diagnostic and Monthly Retainer both deliver white-label PDFs you can send under your own brand. No BillerBrain watermark in the client deliverable. It reads as your denial intelligence work — because you ran it.
What about compounded GLP-1 claims — isn't that already over?
For most payers, yes — formulary exclusion, often not recoverable via appeal. Shield flags these immediately, stops the appeal before it's filed, and shows the exact branded alternative plus the prior authorization pathway for each specific payer. You stop wasting time and get the pivot path in the same report.
How is this different from clearinghouse edits?
Clearinghouse edits catch format errors before submission. Shield analyzes denials after the EOB comes back — looking at CARC/RARC patterns, payer-specific formulary policy language, and drug-specific documentation requirements by plan type. Two different tools for two entirely different problems.
Stop writing off claims
that could have paid.
Send your 20 worst denied EOBs. Get back the verdict — which ones to appeal, which ones to fix, and which ones to stop touching forever.
Get My Free Denial Intelligence BriefNo software login · No EMR integration · 48-hour delivery · Free for first 20 claims