AI-POWERED DENIAL MANAGEMENT

RECOVER $2-4M IN DENIED CLAIMS.

I spent 20 years inside the system that denies your claims. I know how payers decide, which denials are winnable, and what evidence wins on appeal. Now I built the AI that uses all of it.

$262B+ denied annually 75%+ preventable 24+ payers modeled FHIR R4 native
EXHIBIT A
For Health Systems

YOUR DENIALS ARE
COSTING YOU $2-4M/YEAR.

AI that identifies which denied claims you'll actually win — before your team spends an hour on them. Recover $2-4M annually in previously lost revenue. Built by a 20-year insider who architected 200+ payer integrations.

$262B+
Denied Annually
Across All U.S. Payers
CoverageUnlocked Estimate (CMS/AHA)
75%+
Denials Are
Overturnable
KFF 2023
$4.2M
Average Recoverable
Per Health System/Year
CoverageUnlocked Analysis
260x
Projected ROI
Year One
Based on Pilot Modeling
🔮
IDENTIFY WINNABLE DENIALS FIRST

Before you appeal, we score which denials you can win. Your team prioritizes automatically — highest recovery value first. In a 200-denial backlog, focus on the top 15-20 that represent $2-4M in recovery potential.

🧠
94% WIN RATE ON HIGH-CONFIDENCE APPEALS

Pre-built counter-arguments for every payer and denial code. Our AI identifies the claims most likely to win, then generates evidence checklists telling clinical teams exactly what to pull — no guessing, no back-and-forth delays.

WORKS INSIDE EPIC — NOT ALONGSIDE IT

Real-time denial alerts in your Epic clinical workflow. Providers see which claims might be denied before they code them. No separate system. No manual data entry. Integrates natively with FHIR and CDS Hooks.

See the Full Platform →

Or try the live demo — no login required

EXHIBIT B
Platform Intelligence

PREDICTION,
NOT REACTION.
THAT'S THE
DIFFERENCE.

Traditional RCM tools help you manage denials after they happen. CoverageUnlocked predicts which denials you can win before submission and automatically prioritizes them by recovery value. Your team works smarter — fewer denials, better outcomes.

6
Intelligence Systems
Working in Parallel
24+
Payers
Behaviorally Mapped
200+
Denial Pattern
Edges in Graph
15
State Regulatory
Profiles + Enforcement
10
CMS Data Sources
Integrated
22
Enterprise API
Endpoints
INTELLIGENCE SOURCES
🏛
CMS Medicare Advantage Denial Data
475M+ claims, payer-level denial rates
📊
CMS Medical Loss Ratio Reports
Payer profitability and spending compliance
📑
State Insurance Commissioner Filings
15 states, enforcement actions, complaint data
🏥
Hospital Cost Reports & Utilization
CMS provider-level financial data
Kaiser Family Foundation Research
Marketplace denial and appeal benchmarks
🤖
Predictive Self-Play Training
AI vs. AI simulation, 100+ scenario library
FHIR R4 Epic Ready CDS Hooks SAML / OIDC SSO Multi-Tenant RBAC PHI Stripping SOC 2 Type 1 — Q3 2026
19%
Claims Denied Annually

That's 1 in 5 claims. Most are legitimate. Most health systems lack the tools to fight back systematically.

Source: CMS Qualified Health Plan Data
<2%
Patients Who Appeal

The system is designed to make people give up. Fewer than 1 in 50 denials are ever appealed.

Source: AHA 2023
75%+
Appeals That Win

With the right evidence and process, the overwhelming majority of appeals are overturned.

Source: KFF 2023
EXHIBIT C
The Founder

NED LUTZ —
20 YEARS
HEALTH SYSTEM
EXECUTIVE.

Ned spent 20 years at major health systems including Sutter Health and MultiCare — building the denial systems, training the teams, architecting 200+ payer integrations. He knows exactly how payers decide, which patterns predict denial, and what evidence wins on appeal.

  • Sold the Full Epic EHR Platform
    The system that processes claims at virtually every major hospital in America. I know how payer decisions flow through it.
  • 200+ API Integrations Architected
    Sutter Health, MultiCare, St. Charles. I built the data pipelines that determine what insurers see when they review claims.
  • $45M+ Revenue Opportunities Led
    Innovation portfolios, CEO advisory, 4 acquisitions executed. I understand how health system economics and payer contracts actually work.
  • Chief of Staff, Sutter Health
    Chief of Staff to the CIO at one of California's largest health systems. I saw denial management failures at the executive level — and the millions left on the table.
"I sat in the rooms where these decisions were made. I saw how the technology, the vendor contracts, and the business incentives all intersected. The system is not confusing by accident. It's confusing by design. Every unanswered denial is money that stays in the insurer's pocket. I built CoverageUnlocked to change that — first for health systems, and ultimately for every patient."
Ned Lutz
Founder & CEO • 20-Year Health System Executive
EXHIBIT D
For Patients & Families

FIGHT BACK.
AND WIN.

Everything patients need to appeal a denied claim — from AI-powered letters to expert coaching.

🤖
DENIALBOT PRO

Upload your denial letter. Get a complete, ready-to-file appeal in minutes. AI-powered with clinical evidence and regulatory citations. No lawyer required.

Try Free →
📰
THE DENIAL DISPATCH

Free weekly insider intelligence. Real win stories, new state laws, payer intelligence, and the one thing your insurer hopes you never know.

Subscribe Free →
🎓
DENIAL DECODER COURSE

The complete course on reading your EOB, identifying wrongful denials, and filing winning appeals — in plain English. $97 one-time.

Enroll Now →
Free Weekly Newsletter

THE
DENIAL
DISPATCH

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The Denial Fighter Cheat Sheet — free when you subscribe
Real win stories and what actually worked
New state laws and patient rights updates
Payer intelligence: who's denying what and why
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FAQ

COMMON QUESTIONS.

Whether you're a health system evaluating our platform or a patient fighting a denial, here's what you need to know.

CoverageUnlocked provides an AI-powered denial management platform that does three things traditional tools can't: predict denials before claim submission using payer-specific behavioral models, generate winning counter-strategies based on 200+ mapped denial patterns, and identify regulatory leverage points across 15 state profiles. We're built by a 20-year health system insider who knows how payer decisions actually get made inside Epic workflows.
Yes. CoverageUnlocked is built with FHIR R4 data models and CDS Hooks integration designed for Epic EHR environments. Our founder sold the full Epic platform at major health systems and architected 200+ integrations. We understand Epic's data structures and clinical workflows from the inside.
Traditional RCM tools help you manage denials after they happen. CoverageUnlocked's AI actually thinks like a payer — it simulates denial logic, identifies behavioral vulnerabilities, and generates counter-strategies. Our Payer Decision Graph maps denial patterns with insider-level behavioral annotations that no other platform has, because no other platform was built by someone who spent 20 years creating the system.
Request written clinical criteria, file a formal internal appeal with your doctor's letter of medical necessity, then escalate to a free Independent External Review if denied again. Over 75%+ of properly filed appeals win. Our DenialBot Pro tool can generate a complete appeal letter for you in minutes.
Over 75%+ of properly filed appeals are overturned. Yet fewer than <2% of denied patients ever appeal. That gap represents billions in recoverable revenue for health systems and thousands of patients who give up on care they're entitled to receive.
Our intelligence is built on 10 CMS public data sources including Medicare Advantage denial data (475M+ claims), Medical Loss Ratio reports, hospital cost reports, marketplace utilization data, and CMS Star Ratings. We combine this with state insurance commissioner filings, Kaiser Family Foundation research, and our own AI training system that generates and tests appeal strategies against simulated payer personas.
The Mission

BUILT BY AN INSIDER.
BUILT TO RECOVER YOUR REVENUE.

CoverageUnlocked was founded by Ned Lutz, a 20-year health system executive who sold the Epic EHR platform and architected over 200 payer integrations at Sutter Health, MultiCare, and St. Charles. I spent two decades inside The Machine. Now I'm giving health systems and patients the insider playbook to beat it. Our AI-powered denial management platform predicts which denials you can win, generates the evidence to win them, and identifies the regulatory leverage that changes the outcome.