Stop ER claim denials before they happen.
DenyZero codes ER claims with the correct E&M level, flags denial risk against payer-specific rules, and drafts appeals — all before the claim leaves your billing system. Built for community hospitals locked out of $500K enterprise tools.
$0 upfront. We charge 15–20% of recovered revenue — only if it works.
Built with Dr. Ramano Sprueil, MD
Practicing community-hospital ER physician & clinical advisor
ER note
CHIEF COMPLAINT: Right hand laceration.
34F presents after laceration to right palmar surface sustained while preparing food. Length ~4cm, gaping, no foreign body. Tetanus 2 yrs ago.
Wound irrigated, explored — no tendon involvement, NV intact. Repaired with 6 simple interrupted 4-0 nylon after digital block.
DISPOSITION: Discharged with wound care instructions, suture removal in 10–14 days.
Claude Sonnet 4.5 · coded
12.3s · 1,142 tokensE&M
99284
Caught: undercoding
Coder would have submitted 99283. Documentation supports 99284 (laceration repair + decision-making).
CPT
12001
Simple repair, scalp/extremity ≤2.5cm
ICD-10
S61.411A
Laceration without FB, right hand
Built on
Claude Sonnet 4.5
Anthropic
Vercel
Edge runtime
AWS
BAA + dedicated PHI subnet
HIPAA-ready
AES-256 · MFA · audit logs
BAA on request
Hospital ↔ DenyZero ↔ Anthropic
SOC 2 in progress
Type 1 by month 9
The problem
Existing AI vendors took the top 100 health systems.
They left 5,000 hospitals behind.
Cohere Health ($213M raised), Nym ($63M), CodaMetrix ($155M), Fathom ($61M).
- →$500K+ contracts, locked-in multi-year
- →9–12 month sales cycles through enterprise procurement
- →Targets the top 100 health systems
50–300 bed facilities. Thinner margins. A 10% denial rate on $20M ER revenue is $2M of cash flow bleeding out every year.
- →No upfront-priced product they can buy
- →No enterprise procurement budget
- →5,000 hospitals nobody is selling to. That's our market.
How it works
From clinical note to clean claim in five steps.
Upload
Drop in ER notes from your billing system. CSV export works. No EHR integration needed.
Code
Claude Sonnet 4.5 assigns E&M level, CPT, ICD-10, and modifiers in seconds — with reasoning.
Score
Every claim scored against payer-specific denial rules. High-risk claims surface first.
Review
Coders accept or override AI suggestions. Full audit trail. Humans stay in control.
Track
Outcomes monitored. Recovered revenue calculated monthly against pre-pilot baseline.
Time to first result
Week 1
Pilot length
90 days
Hospital cost during pilot
$0
Compared to alternatives
What every other vendor leaves on the table.
| Feature | DenyZeroFor community hospitals | Cohere Health$213M raised · enterprise | Nym / CodaMetrix$60–155M · enterprise | Status quoManual coding |
|---|---|---|---|---|
| Built for community hospitals (50–300 beds) | ||||
| Performance-based pricing (no upfront cost) | ||||
| Pilot in 60–90 days, no enterprise procurement | ||||
| AI-coded E&M, CPT, ICD-10, modifiers | ||||
| Per-payer denial-risk scoring before submission | ||||
| Auto-drafted appeals using original clinical language | ||||
| CSV-in / CSV-out (no EHR integration for pilot) | ||||
| Annual cost to a 150-bed community ER | $87K–$262K | $500K+ | $500K+ | $1–3M lost |
Pricing data from public competitor disclosures + industry analyst reports. Status-quo loss based on average 10–15% denial rate × $20M ER revenue.
Why now
Three regulatory forces compound in 2026.
The window closes when Cohere / Notable / Humata move down-market — they will, within 18 months. We're building the infrastructure community hospitals are forced to upgrade onto, before incumbents can serve them.
Compounding deadlines
CMS-0057-F
Prior Authorization Final Rule
Every payer must support electronic prior auth APIs. Public PA metrics disclosure starts Jan 2026. Every hospital touching MA / Medicaid / CHIP / marketplace QHPs must rebuild their workflow this year.
HIPAA Security Rule
AES-256, MFA, audit logs — mandatory
Required across all covered entities. Hospitals are actively replacing vendors that can't comply. New-entrant window — incumbents can't retrofit fast enough.
Hospital margins
30%+ at negative margin
Performance-based revenue recovery is the only pitch that gets a community-hospital CFO meeting in 2026. There is no budget conversation when there is no upfront cost.
“I've watched coders downcode my charts for safety for years. The hospital writes off six figures of legitimate revenue every year because nobody has time to fix it systematically. DenyZero is the first tool that actually does — and it doesn't cost the hospital anything to try.”
Dr. Ramano Sprueil, MD
Attending Emergency Physician · Clinical Advisor, DenyZero
Pricing
We get paid only when you recover revenue.
No upfront cost. No long-term contract. No procurement budget conversation. We bill 15–20% of verified recovered revenue against your pre-pilot baseline — your CFO signs off monthly before we invoice.
$0 upfront. If we don't recover money for you, you pay nothing.
What's included
- AI E&M leveling, CPT, ICD-10, modifiers — every claim
- Denial risk scoring against payer-specific rules
- Auto-drafted appeal letters for denied claims
- Monthly ROI report tied to your pre-pilot baseline
- BAA + HIPAA-compliant pipeline included
- Coder review queue — humans stay in control
Per community hospital
$87K–$262K
ARR at 17.5% blended fee on $500K–$1.5M of recoverable revenue per year.
10 hospitals
$1M+ ARR
Reachable in 12 months from one signed pilot via clinical-champion intros.
Total addressable
5,000 hospitals
US community hospitals locked out of enterprise tools.
FAQ
Questions every hospital CFO asks first.
Those vendors target the top 100 health systems with $500K+ contracts and 9–12 month sales cycles. None of them economically serve 50–300 bed community hospitals. We charge 15–20% of recovered revenue, not a flat fee — community hospitals pay nothing unless we beat their pre-pilot baseline. We start in ER coding (highest revenue per encounter) and expand into prior auth, billing reconciliation, and scheduling on the same data model.
Yes — under a signed BAA. We operate AES-256 at rest, TLS 1.2+ in transit, MFA, audit logs, role-based access, and a dedicated PHI subnet. BAAs in place: hospital ↔ DenyZero ↔ AWS ↔ Anthropic enterprise. For pilots where the Anthropic enterprise BAA is still being signed, we have a HIPAA Safe Harbor de-identification fallback that lets us launch immediately.
90 days from kickoff. Hospital exports ER notes from Epic / Cerner / Meditech as CSV (no EHR integration required). We run them through the coding pipeline, return clean claims for the coder to review and submit, and track outcomes month-over-month against the pre-pilot baseline. Hospital pays nothing during the pilot. After 90 days we invoice 15–20% of verified recovered revenue. Hospital can terminate any time with no fee.
Revenue cycle director signs, CFO approves, ER medical director sponsors clinically. Our cheat code is starting from a clinical champion (an ER attending who knows the documentation gaps personally) — that compresses procurement from 9 months to 90 days because the conversation skips "should we look at this?" and goes straight to "let's scope the pilot."
Highest revenue impact per encounter ($30–$120 recovered per visit), lowest procurement friction (performance pricing), fastest demo, easiest data export. Inpatient and observation coding involve different stakeholders and longer sales cycles. We earn the right to expand into prior auth (CMS-0057-F driven, month 7+), billing reconciliation, and scheduling once we've proven recovery in ER.
Per-hospital ARR: $87K–$262K at 17.5% blended fee on $500K–$1.5M of recoverable revenue. 10 hospitals = $1M+ ARR. 50 hospitals = $5–13M ARR. Total addressable market: 5,000 US community hospitals × ~$500K endgame ACV (post-RCM-bundle) = $2.5B.
Pilot
Run a 90-day pilot at your hospital.
Zero upfront cost. We measure recovery against your pre-pilot baseline. If we don't exceed it, you owe nothing.
90 days from kickoff to ROI report
No EHR integration required for pilot — CSV export from Epic / Cerner / Meditech is enough.
Your coder reviews every claim
AI suggests, humans accept or override. Full audit trail.
BAA + HIPAA-compliant pipeline included
AES-256 at rest, TLS 1.2+ in transit, MFA, audit logs.
You can terminate any time
No termination fee. Performance pricing — your incentive aligned with ours.