Industry research, 2024 to 2025. Range $150K to $400K per practice. “Industry sources commonly cite that roughly 65% of denied claims are never resubmitted.” Stanislav Sukhinin, CFA, Founder of Sorso.
Five leaks. Heron plugs every one.
Start with whichever one hurts most. We take it from there.
Underpayments
Paid is not the same as paid correctly.
Heron checks every remit against your contracted allowable at zero balance, then goes after what came back short.
Every paid claim checked against your contracts
Short payments taken back to the payer
One office visit, two numbers
Contracted allowable$128.40
Paid Paid$104.12
Short on one visit−$24.28
Illustrative example
Denied claims
Denials worked before the window closes.
Claims are scrubbed before they go out. When a denial comes back, Heron finds the root cause and appeals inside timely filing.
Scrubbed against payer edits before submission
Root cause named in plain language
This week's denials
CO-197Precert absentAppealed
CO-16Missing informationCorrected
CO-50Medical necessityAppeal drafted
Illustrative example
Prior authorizations
Auths filed with clinicals, then chased.
Heron files the authorization with the documentation attached, then follows up with the payer until it clears.
Clinicals attached on the first submission
Payer follow-up until a decision
MRI lumbar spine Approved
Submitted with clinicalsDay 1
Payer follow-upDay 2
Approved before the visitDay 3
Illustrative example
Eligibility and benefits
Coverage checked before the patient walks in.
Coverage, benefits, and auth requirements verified ahead of every visit, not discovered after the denial.
Active coverage and benefits confirmed
Auth requirements flagged early
Tomorrow, 9:30 AM New patient
Coverage activeVerified
Copay$30
Deductible remaining$412
Prior auth requiredFiled today
Illustrative example
Backlog A/R
The old pile, cleared as one project.
Hand us the claims past 90 days. Heron works them oldest first, before timely filing closes, with a clear finish line.
Oldest claims worked first
Progress reported every week
BeforeAfter 90 days with Heron
61-90 days91-120121-180180+
Illustrative
Free audit report
Let us audit your last 90 days of claims.
It costs nothing. You see exactly what is leaking before you decide anything.
Underpayments, denials, and aging claims, by payer and by code.
What Heron can recover
The dollars still inside timely filing, and the work to bring them back.
Where you can save
The upstream fixes that stop the same leak next month.
Three steps. You do one.
Nothing to rip out. Nobody to replace.
Heron
We connect
To your EHR and clearinghouse. No EHR yet? We can bring one.
Heron
We find the money
Underpaid claims, denials worth appealing, auths stuck in a queue, and A/R about to age out.
You
You approve
Your billers keep final sign-off. We do the paperwork and chase the payer.
Your EHR, or ours
Billers keep final sign-off
No per-claim fees
HIPAA compliant, BAA first
“
Six out of ten denials we just wrote off. Not because they weren’t winnable, most of them were. There was simply never enough of us to work them before the filing window closed.
Director of Revenue CycleA physician practice group
Questions billing teams ask first.
Don’t see yours? Ask us on the call, or write to us.
We review your last 90 days of claims and remits and show you three things: where revenue is leaking, what Heron can recover, and where you can save. It costs nothing.
What do you need from us for the audit?
A signed BAA first. Then a 90-day export from your practice management system or clearinghouse. A claims CSV or 835 remit files are usually enough to start.
Is Heron replacing our billing team or our EHR?
Neither. Heron works inside your EHR and clearinghouse, next to your billers, and they keep final sign-off. No EHR yet? We can bring one.
How is patient data handled?
HIPAA-compliant by design. We sign a BAA before touching any data, with end-to-end encryption, US-based hosting, and a full audit trail. Our SOC 2 Type II audit is in progress.
How is pricing structured?
Custom to your practice, with no per-claim fees. We walk through it after the audit, once we both know what is there.
How quickly can we go live?
Most practices on Athenahealth, eClinicalWorks, or Tebra go live in two to six weeks, with about a thirty-minute call from your IT contact. Larger Epic or Oracle Health systems take six to twelve weeks.
Which payers do you work with?
Commercial, Medicare, Medicaid, and managed care, including UnitedHealthcare, Aetna, Anthem Blue Cross Blue Shield, Cigna, Humana, and Centene. Heron uses the routes already open to you: payer portals, clearinghouse connections, and electronic submission.
Are physicians still in the loop?
Always. Heron drafts and submits, but clinicians keep final clinical judgment and approval. We shrink the administrative load, not the clinical authority.
It costs nothing to find out.
A 30-minute call to set up your audit. No PHI on the call.
