Start with the job, not the vendor
A medical billing company evaluating "healthcare AI" is usually really asking one narrower question: can this thing help us appeal more of the denials we're currently letting go? That's a useful filter, because a lot of what gets marketed as healthcare AI — scheduling assistants, eligibility bots, coding copilots — has nothing to do with denials at all. Start from the job you need done, and the field narrows fast.
Only about one-fifth of denied SNF requests were appealed at all (~2,400 of 13,500 denials, HHS-OIG June 2026) — not because most denials are unwinnable, but because appealing takes research time most billing teams don't have on top of everything else on their plate. The tools worth evaluating are the ones built to close that specific gap.
The checklist
| Check | What to ask |
|---|---|
| Policy citation | Does it name the specific payer policy behind the denial, or just repeat the denial reason code back to you? |
| Draft quality | Does it produce an actual appeal letter your staff can review and send, or a summary you still have to write from scratch? |
| Human approval step | Is there a required review-and-approve step before anything is filed with a payer? There should always be one. |
| Audit trail | Can you see the reasoning behind a recommendation after the fact, for compliance and quality review? |
| Volume fit | Is the tool priced and built for your actual claim volume, or is it sized for a hospital system's denial queue? |
| EHR/RCM fit | Does it plug into how your team already pulls claims and files appeals, or does it require a separate workflow? |
| PHI handling | Is a Business Associate Agreement signed before any patient data moves, with a clear answer on what happens to that data afterward? |
On pricing
Pricing for AI denial tools isn't standardized across the market — per-seat, per-claim, and flat monthly models are all common, and what fits depends on your volume and how many staff will use it. Be skeptical of a vendor that either publishes one number meant to fit every billing company regardless of size, or won't give you any ballpark before a long sales process. A vendor who understands your workflow should be able to give you a straight, client-specific number early.
How Vellix AI prices DenialIQ: per client, based on your volume and workflow — never a fixed percentage published as one-size-fits-all. We'll walk through the actual number on a call rather than post a rate card that doesn't mean anything until we know your queue.
Where DenialIQ fits
DenialIQ is built specifically for medical billing companies and small-to-mid independent providers — it checks a payer's specific policy against the claim, drafts a citation-backed appeal, and your staff review and approve every filing. It plugs into your existing revenue cycle process rather than asking you to replace it, and nothing containing patient data moves until a Business Associate Agreement is signed. It is not built or priced for large multi-hospital health systems.