Smart claims & appeals
The Explanation of Benefits workflow that pays for itself.
Snap the bill. Our AI classifies every line, flags balance-billing and No-Surprises Act traps, and drafts an appeal letter your advocate can polish and send.
- Gemini-powered OCR reads the billed lines straight off a photo — no manual re-entry.
- Claude Sonnet drafts assertive or measured appeals per claim.
- Optional KinBridge advocate review after your KBA-verified handoff.
- Every letter versioned; ops overrides never overwrite your original.
- Ops PHI is redacted until the caregiver on the phone is verified.
Every flag we raise cites the CMS rule or federal regulation behind it — you can read the source before you send anything.
From paper bill to filed appeal
Explanation of Benefits
“This is not a bill” notice
Reading document
Step 1 of 4
Photograph the Explanation of Benefits
That is the notice headed “this is not a bill”. Snap it with your phone or drop in the PDF — every line item, billing code, and dollar figure is read for you.
Illustrative interface — the caregiver app is where this happens.
What the audit actually checks
Most bill-review tools stop at arithmetic. KinBridge checks your claim against the same reference data payers use. We maintain a copy of the CMS National Correct Coding Initiative edit tables — over three million code pairs — so when a provider bills two procedures that Medicare says should have been billed as one, we can name the conflict and the modifier rule that governs it.
We also hold the CMS Medicare physician pricing file, so a charge can be compared against the national and state allowed amount for that exact code and place of service. When a line is billed at a large multiple of that benchmark, we say so plainly, and we say what the benchmark is.
Appeal letters are grounded the same way. Instead of paraphrasing the law, the draft cites the governing provision — ERISA's claims-procedure rule, the ACA's external-review requirements, or the No Surprises Act — retrieved from a current copy of the federal regulations. You can read the source text behind every citation before you send anything.
Doing this yourself vs doing it here
An honest comparison of effort, not a promise about outcomes. Every claim is different and no tool can guarantee a payer's decision.
How KinBridge handles a denial
A denial letter is designed to make you give up. It arrives in dense insurer language, references a policy clause you have never read, and gives you a 180-day window you did not know had started.
KinBridge starts where the paperwork does. Upload the denial letter or Explanation of Benefits — the notice headed “this is not a bill”, and a photo from your phone is fine — and we read it for you: the denial code, the specific plan language it leans on, the appeal deadline, and the level of appeal you are entitled to next. You see all of it in plain English before anything is sent anywhere.
From there we draft the appeal. Not a template with your name pasted in, but a letter that cites your plan's own wording, attaches the clinical documentation the insurer says is missing, and matches the tone internal reviewers actually respond to. You read it, change anything you disagree with, and approve it. Nothing leaves your account without you saying so.
Then we keep the clock. Every appeal has a follow-up date, and every follow-up date has a reminder that reaches whoever in your care circle is on duty that week. If the insurer misses their own response deadline, you will know before they do — and you will have the paper trail to say so.
Every flag cites the CMS coding rule or federal regulation it comes from, so you can read the source before you send anything. The letters take about four minutes to review.
Frequently asked questions
- Does KinBridge submit the appeal for me?
- You approve every letter before it is sent. Depending on your insurer we either submit through their portal or give you a ready-to-post PDF with the correct address and reference numbers.
- What if I have missed the appeal deadline?
- Tell us anyway. Many plans allow a late appeal for good cause, and some denials can be resubmitted as a corrected claim instead. We will show you which route is still open.
- Do you need my full medical records?
- No. We ask only for the documents tied to the denied claim — the Explanation of Benefits, the denial letter, and any clinical notes the insurer specifically requested.
- Is my information shared with my employer?
- Never. Employers see aggregate usage only: how many people used the benefit, never who, and never why.