PayerWatch Adds AI-Assisted Appeals Inside Veracity; 3-Minute Drafts Achieve 96% Accuracy on ED Level-of-Care Downgrades

USA - English

EMR-agnostic software accelerates drafting while clinicians stay in control. Clinical Validation and Medical Necessity modules coming soon.

TOWSON, Md., Aug. 21, 2025 /PRNewswire/ -- PayerWatch today announced AI-assisted appeal drafting inside its Veracity™ platform, delivering first drafts in about three minutes and achieving a 96% accuracy rate on Emergency Department Level-of-Care (ED LOC) downgrades, as determined by a blinded panel of RN/MD clinicians auditing the final outputs (see methodology). The solution is EMR-agnostic and plugs into existing workqueues, attachments, and payer submission channels—no replatforming.

"Teams want fewer clicks and stronger first drafts—delivered in the workflows they already use," said R. Kendall Smith, Jr., MD, SFHM, Chief Medical Officer at PayerWatch. "Veracity's AI assembles the facts and drafts the appeal in minutes. A clinician then verifies the content before submission. It's speed and rigor, grounded in PayerWatch's 20 years of denial-management experience."

Flexible operating model

Veracity's AI fits how organizations work today:

• In-house review: Veracity drafts; your clinicians verify and submit.
• Co-review: Veracity drafts; a clinical review team performs QA/edits and returns a ready-to-submit package.
• Managed option: For complex denials and escalations, a managed team handles drafting, verification, packaging, and submission.
  (PayerWatch can provide co-review and managed options through its clinical team when organizations prefer to augment capacity.)

What's available now

• ED Level-of-Care Downgrades: AI-assisted appeal drafts in ~3 minutes, ready for clinician verification.

Coming soon

• Clinical Validation
• Medical Necessity
  Both modules will use the same human-in-the-loop approach and support payer-specific templates, API submissions where available, and RPA/secure uploads where portals are required.

Built to fit your stack

• EMR-agnostic: Works with Epic, Oracle Health (Cerner), MEDITECH, and others via current workqueues, attachments, secure feeds, and APIs—no replatforming.
• Human-in-the-loop: Versioned drafts, audit trails, and required clinician verification prior to submission.
• Operationally pragmatic: Automates attachments and submission where technically permitted; supports payer-specific evidence packets.

Availability

ED LOC drafting is live today for U.S. health systems. Clinical Validation and Medical Necessity are coming soon. To request a 10-minute demo, visit www.payerwatch.com or email [email protected].

Methodology (Accuracy)

The 96% accuracy figure reflects results from a blinded panel of RN/MD clinicians who audited the final AI-assisted appeal drafts at participating pilot hospitals. Reviewers assessed whether drafts contained the required elements for a defensible appeal (e.g., correct dates, factual evidence from the record, coherent clinical rationale, applicable policy references). Results vary by payer, service line, and documentation quality; all AI-generated content requires clinician review and approval before submission and does not guarantee payment.

About PayerWatch

PayerWatch helps hospitals prevent denials and win the ones that occur. Combining Veracity™ (real-time denial and appeal management software) with seasoned clinical expertise, PayerWatch equips revenue-cycle teams with the tools, data, and support to recover revenue and reduce administrative burden. The leadership team brings over 20 years of denial-management experience across community and academic health systems. Learn more at www.payerwatch.com.

Forward-Looking Statements: This release contains forward-looking statements regarding expected product capabilities and availability (including Clinical Validation and Medical Necessity modules). Actual results may differ due to regulatory, technical, payer, or operational factors. PayerWatch undertakes no obligation to update these statements.

Epic is a registered trademark of Epic Systems Corporation. Oracle Health and Cerner are trademarks of Oracle. MEDITECH is a trademark of Medical Information Technology, Inc. All other trademarks are the property of their respective owners.

SOURCE PayerWatch