Know which claims to work today. And which to leave alone.
Arvera reads each open claim’s submission, status and remittance history, decides whether anything can be done yet, recommends the next step, ranks it, and shows exactly why.
For RCM and billing leaders, and the outsourcing firms that run A/R for them.
- HIGHCorrect + resubmitMissing rendering-provider NPIMedicare Part B · $2,850 · fixable today
- HIGHCheck statusNo payer response in 41 daysCigna · $6,120 · follow-up overdue
- MEDRoute to secondaryBalance billable to secondaryBCBS · $840 · secondary on file
- MEDVerify eligibilityCoverage ended before date of serviceAetna · $1,275 · new policy on file
- HIGHAwaiting documentationRecords requested from the clinicHumana · $9,480 · requested 6d ago
- MEDRoute to authorizationAuthorization number missingUnitedHealthcare · $3,310 · owned by auth team
- LOWRoute to codingModifier question on a line itemCigna · $420 · owned by coding
- HIGHClinical reviewNot deemed medically necessaryAetna · $4,300 · appeal window 38d
- MEDHuman reviewUnrecognized code combinationRegional plan · $1,960 · no rule on file
- MEDHuman reviewPayer cannot locate the claimMedicaid · $710 · 277 response
- LOWWait until Oct 2Payer is processing normallyAetna · $5,310 · 277 on Sep 25
- LOWWait until Oct 6Corrected claim sent Sep 22Medicare Part B · $1,140 · wakes on 277 or 835
- LOWWait until Oct 9Inside the follow-up intervalBCBS · $2,080 · accepted 9d ago
The problem
Your system shows 10,000 open claims. It doesn’t say which ones matter today.
A/R teams spend hours opening claims only to find the payer is still processing, the fix belongs to another team, or nothing can happen until records arrive. Arvera sorts the whole inventory first.
- Nothing useful to do yet
- 6,104
- Resolvable administratively
- 1,924
- Need another team
- 811
- Need payer follow-up
- 542
- Need expert review
- 391
- Likely no productive action
- 228
How it works
Four questions, answered for every open claim, every day.
- 01 · State
Where is this claim?
Reads 837, 999, 277CA, 276/277 and 835 transactions to place the claim in its lifecycle: accepted, pending, denied, partially paid.
835 · CO-16 · N290 - 02 · Action
Is anything needed, and what?
Matches codes against versioned rules to pick one of 16 actions, including Wait. It decides first whether any work is needed at all.
Correct + resubmit - 03 · Priority
How urgent is it?
Weighs balance, deadlines, aging and whether work can happen right now. A blocked $40k appeal won’t outrank a $7k fix someone can finish today.
HIGHREADY NOW - 04 · Why
Can I trust it?
Every recommendation lists its matched rule, source, confidence and missing inputs. Staff act or override, and the claim is re-evaluated.
✓ Exact payer-rule match
One claim, start to close
The recommendation changes when the claim does.
When a 277 or an 835 arrives, Arvera updates the claim’s state, matches it against the rulebook and picks the next action again. Most of the time the answer is to wait. When it isn’t, the claim moves to the top of someone’s queue with the fix already found.
- Claim
- CLM-10457
- Payer
- Medicare Part B
- Billed
- $2,850
- Exact source-backed rule match
- Unprocessable claim: no appeal rights, a new claim is the path
- The provider record has a different NPI
Waiting
The most valuable instruction is often “don’t touch this yet.”
When a payer is processing normally, Arvera parks the claim, sets its next evaluation date, and wakes it early the moment a 277 or 835 arrives. Staff never open it just to find nothing has changed.
- Safely deferred
- 6,104
- Need human work today
- 0
- Touches avoided today
- 6,104
- Next evaluation
- Oct 3
Explainability & rulebook
It tells you what it knows, and what it doesn’t.
Root cause and next action carry separate confidence. When codes pin down the problem but the payer’s resolution procedure isn’t on file, Arvera says so and softens the recommendation instead of bluffing.
- Versioned rules with sources. X12 code definitions, payer and MAC guidance, and your own policies, each with an effective date and last-verified date.
- Visible priority math. Every point of a claim’s priority traces to a named factor you can reweight.
- Overrides become rules. Each operator correction is logged with a reason and feeds rule agreement scores.
Safeguards
It recommends. Your team decides.
No auto-submission
Nothing is sent to a payer or clearinghouse. Staff take the action in the systems they already use.
Stops when unsure
Unrecognized codes or unclear root causes route to human review. Arvera never guesses at a correction.
No clinical judgments
Medical necessity and coding changes go to the right specialists. Arvera only routes them.
Full audit trail
Every event, decision, action and override is recorded with a timestamp, operator and engine version.
FAQ
Questions RCM leaders ask first.
Does it submit claims or appeals?
No. It recommends and records. Your staff take every action in the practice management system, clearinghouse or payer portal they already use.
Where do the rules come from?
Standard X12 code definitions (CARC, RARC, claim status categories), published payer and MAC guidance, and your organization’s own policies. Each rule is versioned with its source, effective date and last-verified date.
What happens when it isn’t sure?
It says so. Low confidence in the root cause routes the claim to human review, and medium confidence in the action is shown next to the reason, such as a payer procedure that hasn’t been verified.
What data does it need?
The standard transactions you already exchange: 837 claims, 999 and 277CA acknowledgments, 276/277 status and 835 remittances, plus payer filing limits and follow-up intervals.
How is priority calculated?
A transparent weighted score of balance, deadlines, aging, actionability and blockers. Every point traces to a named factor, and the weights are configurable.
Is this built for outsourcing firms too?
Yes. The same queue works across client portfolios, with actions routed to the team or role that owns them.
Book a demo
See your own claim mix, sorted.
In 30 minutes we walk a denial from 835 to close, show the rulebook behind each recommendation, and talk through what your inventory would look like.
Or email hello@arverahealth.com
Thanks.
We’ll be in touch within one business day with a few times that work.