5
Payer families routed by tested code
Optum/UBH · Aetna · Cigna/Evernorth · Carelon/Beacon · Anthem/BCBS
Denials in. Review-ready appeals out.
ClaimParrot routes behavioral-health denials by care setting, review stage, denial category and payer family, then prepares the evidence checklist, peer-to-peer questions, deadline context and an editable appeal packet for qualified human review.
Fictional demo available · no account, no patient data, and nothing is sent without a person approving it.
Continued-stay denialDeadline: per noticeIOPcare settingPHPcare settingResidentialcare settingInpatientcare settingDetoxcare settingSUDcare settingOutpatientcare settingABAcare settingInitial authorizationreview stageConcurrent reviewreview stageRetrospectivereview stageMedical necessitydenial categoryLevel of caredenial categoryContinued staydenial categoryPrior authorizationdenial categoryCodingdenial categoryNetworkdenial categoryBenefitdenial category
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Care settings, from IOP to ABA
IOP · PHP · residential · inpatient · detox · SUD · outpatient · ABA
9
AI capabilities under a CI contract
A build that breaks a grounding rule does not ship
1
Human approval gate on every packet
Nothing is delivered without a qualified reviewer
The workflow
Route the notice, close the gaps, then hand it to a person.
A denial is a lot of structured detail. The workspace keeps each step separate, so nothing drafted is mistaken for something decided.
Every adverse-benefit determination gets a route before anyone drafts.
- Care setting: IOP, PHP, residential, inpatient, detox, SUD, outpatient or ABA.
- Review stage: initial authorization, concurrent review or retrospective.
- Denial category: medical necessity, level of care, continued stay, prior authorization, coding, network or benefit.
- Payer family, selected by tested application code, not by the model.
Adverse-benefit determination
CP-1048 · Fictional sample · no PHI
Payer familyOptum / United Behavioral Health
Care settingIOP
Review stageConcurrent review
Denial categoryMedical necessity · continued stay
Criteria sourcePayer level-of-care guideline (named in the notice, not reproduced)
Deadline180 days stated in the notice · verify against the plan
Next actionClinical appeal · peer-to-peer available
One workspace from adverse-benefit determination to reviewed packet.
Routing, evidence preparation and human approval are separate steps with separate owners.
01
Deterministic payer routing
Payer family, care setting, review stage and denial category are selected by tested application code. The model extracts facts from the notice; it cannot invent a route, a filing address or a deadline.
02
Evidence and peer-to-peer preparation
A checklist matched to the denial route, neutral clarification questions for a same-specialty clinician, and the official payer resource link. Missing support is flagged, never fabricated.
03
Human review gate
Every packet is an editable draft until a qualified clinician or biller confirms the facts, the exhibits and the deadline. ClaimParrot does not determine medical necessity and does not promise an outcome.
Official sources
Routing points to the payer's own resource, never a guess.
Each route carries the official provider-resource link maintained in application code and reviewed at least quarterly. Criteria sets such as ASAM, MCG, InterQual and LOCUS are identified when a notice names them; they are never reproduced.
Optum / United Behavioral HealthProvider ExpressAetnaDisputes and appealsCigna / EvernorthAppeals and disputesCarelon / BeaconProvider handbookAnthem / Blue Cross Blue ShieldLocal-plan identificationASAM · MCG · InterQual · LOCUSNamed when cited, never reproducedCMS appeal and parity guidanceFederal context
Prepared for review
Prepared for the reviewer, not decided for them.
Three things a utilization-review nurse or biller needs on the desk before a peer-to-peer call or a filing, each with its source attached.
Evidence checklist · continued stay, IOP
3 of 6 linked
Treatment plan with measurable goalsLinked
Symptom-severity measures (PHQ-9, GAD-7 or equivalent)Missing
Functional-impairment documentationLinked
Progress toward goals, last 30 daysLinked
Evidence checklist
Built from the denial route, not a generic template. Each item shows whether the record supports it, needs an update, or is missing.
Peer-to-peer preparation
Neutral questions for a same-specialty clinician
- 01Which criteria set and edition did the reviewer apply to the continued-stay decision?
- 02Which documented symptoms or functional findings were considered insufficient for IOP?
- 03What level of care does the plan consider appropriate, and on what documented basis?
Peer-to-peer questions
The payer's stated rationale becomes neutral clarification questions for a qualified same-specialty clinician. No arguments are put in anyone's mouth.
Deadline context
Every date shows its source
Notice date
06/01/2026
Internal appeal window
180 days, as stated
Expedited path
Available if urgent
External review
After internal appeal
ClaimParrot never substitutes a generic payer deadline for the notice or the member plan.
Deadline context
Only dates extracted from the supplied notice or calculated from explicit language in it. The notice and plan always control.
Queue readiness
Know what is ready before anyone drafts.
Readiness shows the evidence attached, the dates that matter, and the work still open on each claim. Your team can inspect every input behind it.
Claim packet readiness
A fictional queue of twelve claims, normalized around evidence and response windows.
92% · review-ready
review line
- Claim 1: 44 percent
- Claim 2: 58 percent
- Claim 3: 37 percent
- Claim 4: 72 percent
- Claim 5: 54 percent
- Claim 6: 67 percent
- Claim 7: 46 percent
- Claim 8: 76 percent
- Claim 9: 52 percent
- Claim 10: 84 percent
- Claim 11: 61 percent
- Claim 12: 70 percent
12 fictional claimsUpdated now
Who it is for
Purpose-built for the teams that work the queue.
Route IOP, PHP, residential and outpatient denials with the evidence a reviewer actually asks for.
For behavioral-health providers
$500
30-day design-partner pilot, up to 50 fictional or de-identified denials, two users, weekly workflow review.
A BAA is a contract and infrastructure decision, not a badge in the UI.
Tested, not asserted
Every appeal tool says it is accurate. This one puts the claim in CI.
Nine capabilities carry a contract that runs on every commit. A build that breaks one of these rules does not ship.
- Contract test
A fabricated deadline fails the build.
When a notice carries no appeal deadline, inventing one is a graded failure, not a warning.
- Contract test
Claiming enclosures you did not attach fails the build.
A letter that says records are enclosed when none were provided is rejected before it can reach a payer.
- Contract test
Outcome guarantees fail the build.
Generators may argue confidently; they may not promise payment.
- Contract test
Parity is named, never invented.
Appeals may raise MHPAEA parity and level-of-care arguments. Fabricated statutory citations are a tested failure.
- Application code
Payer routing is code, not improvisation.
The same denial routes the same way every time, and every route carries the official payer resource.
- Cross-vendor judging
No model grades its own work.
Quality runs are judged across vendors, on top of deterministic checks that need no model at all.
Know what to inspect before you draft.
Open the fictional sample before you talk to anyone.
Paste the sample denial, watch it route, and read the evidence checklist and peer-to-peer questions. No account, no real patient data.
Scope and limits
What ClaimParrot does, and where your team decides.
Human review stays in the loop
Drafts remain editable. ClaimParrot does not present AI output as a final clinical or legal decision, and it does not determine medical necessity.
Sensitive files stay deliberate
The product separates fictional demos from production integrations and excludes claim details from product analytics. PHI waits for contracts, BAAs and deployment approval.
Deadlines show their source
The notice and plan remain authoritative; calculated dates are surfaced for operator confirmation, never substituted with a generic payer window.
ClaimParrot is not a law firm, insurer, public adjuster or clinical provider. Every output is a draft for qualified review. Read the legal disclaimer.
Reviewed by a person. Every packet.