Denial Intelligence
Auto-classifies denials by root cause. Drafts appeals citing real CMS publications. Produces a prioritized queue billing staff use daily.
For mid-market health systems · 300–1,500 beds
Recover the revenue your RCM is missing.
The intelligence layer for cost and care.
Intelyra is a unified intelligence platform that reads your clinical documentation and your financial signals in one loop, catching the leakage your point-tool vendors literally cannot see. We sit on top of your existing RCM stack and prove the revenue recovery in 90 days.
The problem
$6 to $25 million walks out of your hospital every year.
A mid-sized hospital with $200–500 million in net revenue is losing $6–25 million a year to prior authorizations, underpayments, and denials. The money is leaving in pieces, a coding nuance Waystar can't see, a payer behavior pattern your billing team caught last quarter but couldn't quantify, a contract clause nobody has time to enforce.
You've read the eighteen-page enterprise RCM brochures. You know how that goes, a six-month implementation, a strategic-partnership PowerPoint, and a number you find out next year. This is the opposite of that.
What Intelyra is
One platform. Six intelligence modules. One source of truth.
We deploy the highest-leverage module first, prove the ROI, and add the rest as the trust compounds. Every alert clicks through to its source. Every appeal cites the actual CMS publication. The argument to your board is no longer "the AI says so", it's "this NCD says so, and here is the document."
Pre-Claim Risk
Same engine, run pre-submission. Scores claims for denial probability before they go out, surfaces high-risk claims for billing review.
Leakage Radar
CFO dashboard aggregating denial, leakage, and recovery signals. Every figure clicks through to source documents in the Vault.
Prior Auth Intelligence
Read-only intelligence over your existing PA workflow. Watches CMS-0057-F response clocks. Per-payer compliance scorecards.
Coding Assist
Clinical NLP suggesting ICD-10/CPT/HCC codes from clinical documentation. HIPAA-compliant physician attestation app.
Quality Gap Closer
HEDIS and VBC quality measure scanning. Care team alerts in EHR workflow. Patient outreach orchestration.
Why now
The regulatory environment shifted in providers' favor for the first time in a decade.
What changed in January
As of January 1, 2026, Medicare Advantage, Medicaid, and Marketplace QHP payers face new prior authorization requirements under CMS-0057-F: faster response times, specific written denial reasons, public reporting of prior authorization metrics.
CMS-0057-F, effective January 1, 2026,
§ 422.631(c)(2): 7 calendar days for standard PA responses, 72 hours for expedited.
Where we start
We deploy, within 90 days, the highest-dollar, most-measurable piece of the revenue cycle: denial intelligence. Every denial auto-classified by root cause. Every appeal auto-drafted citing real CMS publications. Your team works a prioritized queue every morning instead of a spreadsheet.
Over the following 6 to 9 months we introduce additional capabilities, prior authorization automation, AI-assisted coding, and quality measure alerts. But the first 90 days are denials. Every one classified, every appeal drafted in time, every dollar counted.
About
We are not a software company that learned healthcare.
We are healthcare professionals who built software because the tools we needed did not exist. Our founders bring an unusual combination: the clinical instincts to know what documentation matters at the point of care, the financial fluency to know exactly what that documentation is worth on a claim, and over two decades of experience building highly secure, highly scalable enterprise-class healthcare software.
That intersection, where care decisions become cost outcomes, is the problem Intelyra was built to solve.
More about who built this →See the dollars your RCM is missing.
One 30-minute conversation. No deck.