Insurers Underpay.

Third Rail Intelligence Finds It.

Most of what insurers owe never gets collected.

Third Rail Intelligence recovers it.

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See What It Finds

Does Any of This Sound Familiar.

You run billing.

You submitted it correctly. You appealed it. They said no again. The money never came, the treatment got delayed or abandoned, and now it's just sitting there. Except you know it shouldn't have been denied. You did everything right. You just can't prove it.

You own the practice.

Six figures sitting in a write-off column. Your billing team did everything right. The insurer said no anyway. At some point your team stopped fighting because fighting wasn't working and you had a practice to run. That money didn't disappear. The argument to recover it just hasn't been made yet.

You manage the portfolio.

Across your sites there are abandoned claims your operators wrote off, underpayments nobody caught, and denial patterns running identically at every location touching the same payer. None of it is on any report you've seen. All of it is recoverable. The only question is how much.

Six Figures. Three Places.

Third Rail Intelligence recovers all three.

Active Denials

The appeal failed. The insurer is counting on you stopping there. Third Rail Intelligence doesn't.

Typical recovery: $10,000 to $50,000+ per claim block

Written-Off Claims

Closed and forgotten. Most were lost on the wrong argument. Third Rail Intelligence finds the right one.

Typical recovery: $40,000 to $100,000+ including multi-block claims

Paid Claims

The insurer paid. Just not what your contract says they owe. That gap compounds every year.

Typical recovery: $40,000 to $120,000+ per annual audit

This Is What the System Produces.

Every case is different. The process is the same. The system reads the record, finds what the insurer got wrong, and builds the complete response.

THIRD RAIL INTELLIGENCE
CASE FILE
CASE REF:TRI-2024-001
PRACTICE TYPE:Specialty Oncology / Infusion
PAYER:Major Commercial Carrier, California
CLAIMS IN SCOPE:3
TOTAL AT ISSUE:$93,404.26
PRIOR STATUS:3 internal appeals exhausted.
Meet and Confer invoked.
No substantive response received.
Time since last action: 3 months.
INTAKE DOCUMENTS REVIEWED
— Prior authorization orders (2)
— Explanations of benefit, all three claims
— Internal claim inquiry correspondence
— Uphold letters, all dispute levels
— Meet and Confer case record
— Payer medical policy
— Denial code and remark code record
— Clinical administration records
FINDINGS
FINDING 01
The payer's uphold letter cited step therapy non-compliance as the basis for denial. The clinical record submitted with the original authorization documents two prior failed therapies meeting the payer's own step therapy criteria exactly. The payer's own authorization arm reviewed the same record and approved the treatment. The claims denial was issued without clinical review. No uphold letter at any level identifies a specific criterion as unmet or acknowledges the prior therapy documentation.
FINDING 02
The payer applied a contracted-rate adjustment code to infusion administration lines on every denied claim, under the same NPI, on the same dates it denied the drug lines as non-contracted. A contracted-rate adjustment code applies only where a contracted fee schedule exists. The payer applied both codes to the same claim simultaneously.
FINDING 03
The payer issued three materially different denial rationales across its own correspondence within 65 days. Each rationale presupposes the other two are not the operative issue. The payer cannot sustain any of the three positions against its own record.
FINDING 04
The payer's authorization was issued with zero clinical documents on file, for a more clinically advanced patient profile than was present at the denied dates of service. The claims denial was issued with a complete clinical chart. The payer's automated authorization arm approved what its claims arm denied, at a harder clinical threshold, with less information.
FINDING 05
The payer opened and closed a formal review of the appeal in 23 minutes. A second department held the same appeal open simultaneously with no awareness the first had closed it. Three internal case numbers were generated on one dispute across two departments with no cross-reference between any of them.
OUTPUT PACKAGE
Complete response package built and ready to submit. Every document the claim requires, at every level of escalation available. Practice submits directly.
TOTAL AT ISSUE:$93,404.26
FINDINGS COMPLETE:5 of 5
OUTPUT PACKAGE:Complete. Ready to submit.
Identifying details withheld. Format and findings depth are representative of actual system output.

Five findings. One complete response package. Built entirely from the insurer's own records. The practice reviews, signs, and submits. Nothing else is required.

This system recovered $131,000 for an oncology practice on a multi-block claim that had been denied and appealed over four months, and recovered a $32,400 single-block claim for an independent rheumatology practice.

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How It Works.

Three steps. No new software integration. No disruption to your existing operations.

Upload your documents.

Claims data, fee schedules, denial correspondence, prior authorizations. Submitted through an HIPAA-compliant secure portal. Nothing else is required from your team.

Third Rail Intelligence runs.

The system reads the full document record, identifies contradictions, omissions, miscoding, and rate discrepancies, and builds a complete response package for each recoverable finding.

You receive findings and a complete package.

Documented, drafted, and formatted. Your team reviews and submits.

Pricing

Third Rail Intelligence runs continuously alongside your existing operations. New claims, new denials, and new underpayments are generated every month by normal practice activity. The system works that volume as it comes in.

Nothing is owed unless something is recovered. The fee is a percentage of what is found and recovered, set in writing before work begins. No retainer. No upfront cost.

Every relationship starts with a free pilot. One claim block, one payer, your data. If nothing is found, nothing is owed and nothing has changed.

The findings are in your claims data.

One file. One claim block. Third Rail Intelligence runs on your actual data and returns documented findings before anything is agreed to.

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All submissions are handled in full compliance with HIPAA. No patient or practice data is disclosed under any circumstances.

6518 Lonetree Blvd
Suite 2061
Rocklin, CA 95765

6518 Lonetree Blvd
Suite 2061
Rocklin, CA 95765

6518 Lonetree Blvd
Suite 2061
Rocklin, CA 95765