Monitor denied claims across your clinic.

Overview

A denied claim is money waiting on someone’s next move. AI says why it was denied, an agent drafts the appeal with its sources, and your team gets both in Slack to review and send.

Prerequisites

These are the pieces we suggest having ready before you switch this workflow on. Your clinic may set things up differently, so treat the list as a guide.

• Insurance claims sent through Sovica
• Slack connected to Sovica

How to use this template

Once it opens, you’ll see the blocks joined up in order.

1. The Claim denied trigger runs when an insurer denies a claim. Choose the insurers you want covered, and the run picks up the denial code as it comes in. Denials that arrive on paper count too, as soon as your team records them on the claim.
2. The Summarise record block uses AI to explain the denial in plain words. Say what your team needs to know, and an example prompt would be:

   In one sentence: which claim {Record} was denied, the reason the insurer gave, how much is at stake, and what would need to change for it to be paid.

3. The Custom Agent block drafts an appeal that cites the visit note and the insurer’s rule, so whoever reviews it can check its sources. Point it at your clinic’s appeal letters, so that it writes the way your billing team does. It never sends anything itself: the draft waits on the claim until a person has read it.
4. The Send Slack Message block posts the {Summary} and the draft to your billing channel for your team to review. Add a link to the claim and name someone to own it, as an appeal has a deadline and a message in a channel can be missed.