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Insurance companies are using AI to automatically reject claims at scale, leaving medical practices buried in appeals work they can't handle. Korex is a startup building software to audit these rejections and generate policy-backed appeals automatically.
- Insurance carriers have replaced human claims adjusters with automated rejection systems, causing a spike in erroneous denials that practices lack resources to challenge
- Medical billing departments can't manually contest every denial, so millions in legitimate claims go unpaid or get shifted to patients as unexpected bills
- Korex's approach: automatically cross-reference denial codes against clinical charts and payer policies to generate verified appeals in one click, with a $299/month pricing model per clinic
ABA clinics face soaring demand but razor-thin margins due to a maze of state-and-insurer reimbursement rules. While outright claim denials run around 3%, nearly 30% of submissions require costly rework that slashes payments; AI-driven platforms like Camber halve that manual burden and speed up cash flow.
- Only ~3% of ABA claims are outright denied, but ~28% require rework, and each resubmission cuts payment by more than half—so 3-4 rounds of back-and-forth nets clinics only about 25% of the original charge, often months late.
- Identical ABA sessions can be reimbursed up to 2.09x differently depending on the state, and manual claim corrections cost up to 6.3x more than automated ones, pointing to roughly $21 billion in potential annual savings industry-wide.
- Clinics typically take two years to raise their first-pass claim success rate from 77% to 92% on their own, but AI platforms like Camber cut manual interventions by more than half within just two months.