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Bitewing
Bitewing
§ Solutions · For RCM Directors

Precision-first variance detection
with an operational queue.

The question an RCM director actually wants answered: are these flags real, and can my team work the list without drowning in false positives? Bitewing is precision-first — 90%+ target precision on flagged variances — and every row shows due date, estimated recovery, missing exhibits, and the payer's historical win rate, so the team starts on the row where yield is highest.

90%+ precision targetPre-drafted packetsSLA-aware queue
APPEALS QUEUE · TODAY · ranked by (est. recovery × confidence) − SLA
34 ready≈ $402 this week
0291-EMadison Ave 14Aetna PPOConnection DentalD27402d$239✓ complete71%
0284-CAustin 21Delta PremierD43415d$25✓ complete83%
0274-GChicago 09Aetna PPOConnection DentalD29503d$47✓ complete71%
0271-KBoston 06Cigna DPPOD23917d$18⚠ 1 missing92%
0268-MDenver 07United ConcordiaD02749d$32⚠ 2 missing76%
0265-QSeattle 14Delta PremierD491012d$41⚠ 1 missing83%
High Mid LowIllustrative sample · no PHI
§ 01 · Guardrails

Six controls that keep precision honest.

Versioned contracts (never compare 2026 payments to a 2025 schedule). Entity resolution (canonical TPA alias map). Routing confirmation (actual paid-by against known leased networks). Identity checks (provider / TIN / NPI reconciliation at the location level). Filtered confidence (high-confidence → act, borderline → queue). Yield prioritization (recoverable dollars per hour of team attention).

V.E.R.I.F.Y. · six controls the discipline runs on
V
Versioned contracts
Compare 2026 payments to 2026 schedules — never a stale one.
E
Entity resolution (TPA aliases)
Canonical alias map collapses "CareFirst", "Connection Dental", and TPA variants.
R
Routing confirmation
Actual paid-by checked against known leased-network routes.
I
Identity checks (TIN/NPI)
Provider / TIN / NPI reconciled at location level before the claim is scored.
F
Filtered confidence
High-confidence acts. Borderline queues. Low parks until more evidence lands.
Y
Yield prioritization
Recoverable dollars per hour of team attention, not raw flag count.
§ 02 · Queue ranking

How the list sorts itself.

Each row carries a recovery score, an SLA countdown to the reconsideration window, an exhibits-complete flag, and the payer's historical win rate. High-score, short-SLA items float to the top. Items with missing exhibits sit in a parked bucket with a specific ask to the office manager — no silent drops, no lost appeals.

rank = (est. recovery × confidence) · SLA urgency · exhibits complete
Est. recovery × confidencePriority score
High-yield × high-certainty floats to the top. A $30 flag at 99% can outrank a $400 flag at 70%.
SLA countdownUrgency boost
Closer to the reconsideration deadline = ranked up. Red chips at ≤3 days, amber at ≤7.
Exhibits completeUnblocked
Missing EOB page, missing pre-auth, missing radiograph → parked with a specific ask to the office manager.
Payer win rate (180d)Yield realism
Lanes that reliably recover rank above brittle lanes. Chronic underpayers get flagged for CFO renegotiation input instead of more appeals.
rank = (est. recovery × confidence) · SLA urgency · exhibits complete
§ 03 · Win rate by payer

Which lanes reliably recover.

Appeals don't all land the same. Acceptance depends on payer, routing path, and claim type. We publish historical win rate per payer and per routing path on a trailing 180-day basis — so your team knows where effort pays back, and where renegotiation is the better lever than litigation.

per-payer · per-routing-path · trailing-180 · trend
Win rate · trailing 180 days · per payer / routing path
MetLife PDP+92%n=18
Cigna DPPO91%n=42
Delta Premier83%n=51
Aetna PPO (direct)82%n=22
United Concordia76%n=14
Aetna → Connection71%n=34
Humana Preferred64%n=9
What it tells you
Aetna via Connection Dental pays back at 71% — the lane where renegotiation is the better lever than another appeal cycle. MetLife and Cigna land above 90% — keep running those packets. Humana at 64% gets parked unless the dollar is above a threshold.
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