Why did a bot reject my £2,400 ACL reconstruction claim?

The why and what to do about it

Automated insurer systems create increasingly complex hurdles to claim your revenue, leaving many valid claims on the table and losing you thousands.


We are UK's only proactive Healthcode shield that optimises your claims before submission.


Designed as PMS add-on or browser page/app. No need to replace software.


Result: faster and higher payouts.

We align your practice with insurer logic, automatically.

No more manual rework and billing mismatches.

Revenue Alert
09:14 AM
Event:Implant Log Missing
Location:Billing Audit
Action:Recharge Invoice Generated
Resolution:Revenue Secured (+£350)
Status: You are protected
Fee Update
09:42 AM
Event:Injection Fee Update
Location:Fee Schedule
Action:Code W9030 Adjusted
Resolution:Fee Updated (+£75)
Status: Value Secured
Complexity Check
10:05 AM
Event:Arthroscopy Complexity
Location:Clinical Notes
Action:Debridement Added
Resolution:Uplift Verified
Status: Validated
Anonymised Network Data (Orthopaedics sample)

Active revenue logic

Our engine defends against the three main causes of revenue loss. It verifies claims pre-submission to stop rejections, automatically chases shortfall gaps, and prevent revenue leakage. Total financial coverage.

INNER CIRCLE OFFER

Priority allocation

We strictly cap onboarding to ensure system stability. Inner Circle Partners bypass the waitlist for immediate integration. Your upfront commitment is 100% credited to your balance—covering your first ~£75,000 of processed revenue.

Manual resolution

Our core logic automates 97% of claim volume. The remaining 3% (complex clinical disputes) are routed to specialists for manual resolution. Enterprise infrastructure combining automated speed with human safety.

Privacy by design

Strict enterprise-grade Clinical cross-referencing.

To ensure coding accuracy, our engine performs a local semantic analysis of your anonymised appointment notes to cross-reference clinical activity against billing codes (e.g., verifying that 'Implant Log' or 'Total Hip Replacement' keywords match the submitted CCSD complexity).

This validation occurs exclusively within your local practice environment.

We do not store or cloud-host patient records. The only data that leaves your system is validated numerical strings, ensuring 100% GDPR compliance while preventing under-coding errors.

Billing parameters

Codes, policy rules, excess

Confidential care records

Clinical notes (encrypted/ignored)

Patient identity

Personal data (redacted)

ICO RegisteredCompliance: UK DPA 2018
UK Data ResidencyLondon (europe-west2)
AES-256 SecurityAt Rest & In Transit

The DNA & Shortfall Guard

Protection against no shows and coverage gaps.

Protocol Preference

Secure at booking

Patient verifies card via Stripe secure portal. No charge is made yet.

The encrypted vault

Card captured securely on file. Tokenised for safety, verified for validity.

The Trigger

Attend: Insurance billed / Card held
Shortfall: Charge the card
No show: Auto-process DNA fee

"It turns a Shortfall or No Show into protected revenue. You stop chasing patients, and your cashflow becomes predictable."

The Recovery Efficiency Paradox

Performance comparison

Specialty
Annual claims
240
Avg claim value
£1,900
Annual revenue
£456,000
Initial rejection rate
30.0%
Annual rejection amount
136,800
Gross value lost to first-pass insurer automated barriers
Recovery Yield Analysis
Track 01
In-house admin
Benefit auditValue
Initial rejection exposure136,800
Recovery of rejections (47%)63,840
Staff cost (PA/admin)68,400
Net recovery£-4,560
In-house ROI
-7%
Forensic IRR
-20%
Yield gain adjusted for 2-month manual chasing delay.
Track 02
Billing agency
Benefit auditValue
Initial rejection exposure136,800
Recovery of rejections (80%)109,440
Commission (7%)31,920
Net recovery£77,520
Agency ROI
243%
Forensic IRR
1343%
Liquidity drag from 2-month reporting and payment lag.
Track 03
Onetoclaim proactive
Benefit auditValue
Initial rejection exposure136,800
Prevention of rejections (98%)134,064
Subscription9,120
Net recovery£124,944
Onetoclaim ROI
1370%
Forensic IRR
16440%
1-month capital velocity through proactive autonomous prevention.
Forensic IRR: identifies the annualized efficiency of your capital recovery. It accounts for the velocity of cash flow, adjusting for reporting delays and payment cycles.

The OneToClaim Value Stack

Zero cherry-picked rejections
No claim left behind. 98% vs 90% payout.
£168,720
recovered
Reduce unpaid sessions & shortfall
80% recovered.
£19,200
per year
Get paid 60 days faster
60 days = 5% * AR, plus £1.4K in admin
£1,520
cash flow benefit
Fair flat rate saving
Replaces the 5% "Agency Commission Tax" with a predictable flat fee.
£31,920
per year
Instant Practice Connectivity
Real-time automation via Zapier, Slack, etc
£1,440
per year
Est. invoice revenue£48,000 / mo
Est. annual revenue£576,000 / yr
Total Annual Upside (Gross)£222,800

Secure partnership terms

Orthopaedics • Cliniko
Historical 12-Month Audit
Waived
Value £500
Associate
3% of 3-mo revenue average
£1,425/ mo
Min. £200 / mo
Best value
Inner Circle
Priority subscription • Priority queue • Roadmap contribution • Includes £143K revenue (~3 months)
£2,850 retainer
Min. £100 / mo

Cliniko foundation allocation

March🟢 Priority 3 Avail.
April🔵 Wait List
Our 60-Day Value Guarantee: If we don't recover your initial investment in total value within 60 days, we work for free until we do.

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