5
Payer families routed by tested code
Optum/UBH · Aetna · Cigna/Evernorth · Carelon/Beacon · Anthem/BCBS
Denials in. Review-ready appeals out.
ClaimParrot routes de-identified behavioral-health denials by care setting, review stage, denial category and payer family, then drafts the evidence checklist, peer-to-peer brief, deadline plan and an editable appeal packet. A person checks every packet before your clinician signs it.
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
8
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.
67%
ready for sign-off
8 of 12 claims
Ready for sign-off
867%
- CP-104141d
- CP-104323d
- CP-10454d
- CP-104758d
- CP-104832d
- CP-105028d
- CP-105147d
- CP-105219d
Gathering evidence
217%
- CP-104415d
- CP-104974d
At risk
217%
- CP-10427d
- CP-10469d
12 fictional claims · no PHI
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
$29
per appeal packet, $99 for level of care. Your first packet is free, and a person checks every one before it reaches you.
No PHI in, so no BAA needed. Software drafts every packet and a person checks it.
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.
Denial guides
Know what to inspect before you draft.
Guide
Behavioral-health prior-authorization denials: sort them, then appeal
Prior authorization
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.
No patient data, by design
Requests arrive de-identified and packets leave with placeholders your team fills in. ClaimParrot accepts no PHI, so there is no BAA to sign, and claim details stay out of product analytics.
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 or clinical provider. Every output is a draft for qualified review. Read the legal disclaimer.
Questions
What teams ask before a pilot.
What is ClaimParrot?
ClaimParrot is denial and appeal software for behavioral-health providers and the billing and revenue-cycle companies that serve them. From a de-identified denial it pulls out the payer's stated reason, codes and deadline, builds an evidence checklist and drafts an editable appeal packet; a person checks every packet before release, and a qualified person at your organization reviews, signs and submits it. It is operated by KERA Tech Solutions L.L.C., Prizren, Kosovo.
Which behavioral-health settings does it handle?
Intensive outpatient (IOP), partial hospitalization (PHP), residential, inpatient psychiatric, detox and substance use disorder programs, outpatient therapy and psychiatry, and ABA. Each denial is routed by care setting, review stage (initial authorization, concurrent or retrospective), denial category and payer family.
Does ClaimParrot decide whether care is medically necessary?
No. It organizes the payer's stated rationale, the deadlines and the record into a draft. Medical-necessity and level-of-care judgments belong to qualified clinicians, and nothing is sent until a person approves it. ClaimParrot also does not reproduce licensed criteria such as ASAM, LOCUS, InterQual or MCG.
Can we send real patient data?
No. ClaimParrot accepts de-identified cases only: send the payer's stated reason and a clinical summary without names, ID numbers, dates or contact details, and the packet comes back with placeholders your team fills in. Because no protected health information is accepted, no business associate agreement is needed, and ClaimParrot does not sign one. The Trust & security page lists retention periods and subprocessors.
How much does ClaimParrot cost?
Appeal packets are $29 (standard) or $99 (level of care), and the first one is free. Appeal Desk plans are $590/month for 10 packets or $1,290/month for 25. Billing partners pay wholesale ($19 / $69). A 30-day design-partner pilot of the software workspace costs $500. The pricing page lists what each includes.
Where can I learn how a specific denial or payer works?
The free resource library covers denial guides (medical necessity, level of care, continued stay, peer-to-peer and more), CARC denial codes, payer appeal rules, letter templates, free tools and sourced denial statistics. No account is needed.
Reviewed by a person.Every packet.