CMS WISeR launched Jan 1, 2026 · denial rates up 25% in 2 years

We appeal your denied claims.
You pay 30% of what we recover.
Or nothing.

ApexClaims drafts and files appeals for denied medical claims at specialty practices. Pain management, GI, cardiology, neurology. Contingency-based: you pay nothing if we recover nothing. Most practices have 4–8% of annual revenue sitting in unappealed denials.

Email to book a call See a sample ↓
CMS WISeR: launched Jan 1, 2026 · 17 procedures · 6 states
Average recovery: $8–22k per quarter for a 3-physician specialty practice
Pain managementGastroenterologyCardiologyNeurology1–10 provider practicesWISeR pilot states (AZ NJ OH OK TX WA)
30%
Take-rate on successfully appealed claims. $0 if we recover nothing.
48hours
From denial intake to filed appeal. Most practices wait weeks before someone gets to it.
4–8%
Of annual claims revenue is typically lost to unappealed denials at specialty practices.
7.4%
Medicare Advantage denial rate for pain mgmt procedures in 2025 — up from 5.9% in 2023.
Process

How a single appeal moves through ApexClaims.

We integrate with your practice management software OR you forward ERAs to a dedicated inbox. Either way, we never touch your billing system directly.

Engagement timeline

Your time required: ~15 min/month (intake setup)
Day 0
Denial arrives at your practiceERA/EOB indicates claim denied. Reason code, amount, payer.
Payer
Day 0–1
Denial flows to ApexClaimsEither via integration (Athena, eCW, Kareo) OR forwarded inbox. We classify by appeal-success probability and claim value.
Us / your PM
Day 1
We assess: appeal or pass?Not every denial is worth appealing. We pass on long-shots and bill nothing on those. We appeal where probability × claim value justifies the work.
Us
Day 1–2
Appeal letter draftedDrafted referencing actual medical necessity, LCD policy, payer-specific language. Drafted on your letterhead.
Us
Day 2–3
Senior reviewEvery appeal reviewed before filing. Nothing goes out without sign-off.
Us
Day 3–5
Filed with payerOn your letterhead, in the payer's required format, with attached documentation.
Us
30–90 days
Payer redeterminationMost appeals resolve within 60 days. You see the payer response in your EOBs.
Payer
On recovery
We invoice 30%Of the recovered amount. $0 if recovery was $0. Weekly status report by Loom.
Us
Sample

See what a real appeal letter looks like.

A redacted sample appeal for a Medicare pain-mgmt denial of a bilateral facet joint injection. Same format paying customers receive.

apexclaims.moorageco.com/sample/mountain-pain-specialists
2-page appeal letter · fictional case · LCD-citing format real appeals follow Open full sample in new tab →
What you get

What you get for the 30% take-rate.

Drafted appeal letters

Cite LCDs, medical necessity criteria, attached documentation. On your practice letterhead.

Denial classification

We assess each denial. Appeal where probability × value justifies. We pass on long-shots — no false billing.

48-hour filing SLA

From denial intake to filed appeal within 48 business hours. Window discipline matters.

Weekly status report

Loom + spreadsheet showing what we appealed, what we passed on, what recovered.

Payer follow-through

If a payer requests additional info, we handle the back-and-forth. No additional fees.

Direct contact

Every email gets a response within 24 hours. No ticket queue. Your account is owned by one person.

Security & data handling

HIPAA-grade handling, plain-English commitments.

We handle PHI. Here's exactly how, with no jargon.

HIPAA BAA

We execute a Business Associate Agreement before any PHI is shared. Standard ApexClaims BAA available on request.

Read-only PM integration

When integrated with Athena / eCW / Kareo, our access is read-only. We never modify billing records.

PHI retention

Patient PHI retained only while appeals are active. Deleted within 60 days of final payer decision. Earlier on request.

Never used to train

Patient records and clinical notes are never used to train any model. Period.

Don't want PM integration? Forward your ERAs / EOBs to a dedicated ApexClaims inbox. We classify and appeal from there. The flow is identical, just less automated. Most small practices prefer this.
Pricing comparison

Contingency pricing only works when the math works.

Traditional medical billing companies charge 6–12% of all collections as ongoing retainer — regardless of whether they're actually recovering denials. We only get paid when we recover claims that would otherwise have been written off.

ApexClaims30% take-rate · only on recoveries · $0 if no recovery
30% of recovered
30%
Traditional RCM company6–12% of ALL collections · ongoing retainer
6–12% of all collections
6–12% all
In-house denials managerSalary + benefits · $55–80k/yr
$55–80k/yr salary
$55–80k/yr
External law firm appeal$300–800/hr · partner-driven
$3–10k per case
$3–10k/case

Source: 2025–2026 specialty practice management benchmarks (MGMA), Medicare Advantage denial-rate trend reports, CMS WISeR program documentation. The 30% contingency only works because we batch-process and pass on low-probability appeals — the math wouldn't pencil for a human-only RCM firm.

Who we are

We do one thing: appeals.

ApexClaims LLC focuses exclusively on appealing denied claims at specialty medical practices. We don't do general billing. We don't do collections. We appeal.

ApexClaims LLC is a Delaware-registered company. Single product: contingency-based denial appeals for specialty practices in pain management, gastroenterology, cardiology, and neurology.

Our process is repeatable: classify each denial, appeal where probability and value justify, file on practice letterhead within 48 hours of intake, follow through. We pass on long-shots — no false invoicing on appeals that statistically won't recover.

Every practice has one ApexClaims contact. Direct email. 24-hour response time on inbound. Weekly Loom + spreadsheet status report.

ApexClaims LLC · Delaware · HIPAA BAA available
Every email gets a 24-hour response. Weekly status update by Loom + spreadsheet.
Pricing

Contingency-based. No retainer.

30% of successfully appealed amounts · $0 if no recovery

Includes

  • Drafted appeals on your letterhead
  • LCD/policy citation per appeal
  • Senior review before filing
  • 48-hour filing SLA from intake
  • Payer follow-through (additional info requests)
  • Weekly Loom + spreadsheet status report
  • HIPAA BAA
  • PM integration (Athena / eCW / Kareo) OR forwarded ERAs

Not included

  • Initial claim submission (we handle denials, not submissions)
  • Patient billing or collections
  • General coding consulting
  • Litigation if a denial goes to court
  • Per-occurrence retainers (we only invoice on recovery)
Two guarantees. (1) If we file an appeal and the recovery is $0, you pay $0 — no exceptions. (2) Quarterly: if your total recovery doesn't exceed 3× what you'd have paid an in-house denials manager (pro-rated), we end the engagement at your discretion with no fee.
Honest answers

What practices ask.

Do you have other clients we can reference?
Not yet. ApexClaims launched in May 2026 — you'd be among the first practices we appeal for. The sample on this page is fictional. The contingency model is the de-risk: if we don't recover, you pay nothing.
What if I already use a billing company?
ApexClaims sits alongside existing billing services. We focus specifically on denied claims that would otherwise be written off. Most billing companies don't have time or expertise for the appeal-letter work; we don't compete with submission and collections work — we cover the gap.
How do you decide which denials to appeal?
Every denial is scored by (a) claim value, (b) denial reason code success probability historically, (c) availability of supporting documentation in the record. Appeals where probability × value > $400 (our minimum recovery threshold) get filed. Others we pass on and tell you. No false invoicing.
What's the BAA / HIPAA situation?
We execute a HIPAA Business Associate Agreement before any PHI is shared. Standard ApexClaims BAA is available on request. We carry $1M / $3M cyber liability + professional liability.
Can you handle specialty-specific procedures?
We specialize in pain management, GI, cardiology, neurology — these are the specialties with both high denial rates and high per-claim values. For other specialties (ortho, derm, urology, etc.), reach out and we'll tell you honestly whether we're a fit before quoting.
How long until we see results?
First appeals filed within 48 hours of intake. Payer redetermination takes 30–90 days for most lines. Most practices see first recovery in month 2.

4–8% of your annual revenue is sitting in unappealed denials.

Book a 15-minute call. We review your last 30 days of denials together, on the call. If the math doesn't work for your practice, we tell you on the spot.

Email to book a call