The average surgical practice loses $8K–$15K per month to prior auth denials, systematic downcoding, and underpayments your billing team accepts without a fight. We find every dollar, recover it, and make sure payers can't quietly take it again.
Prior auth delays. Auto-downcoded claims. Underpayments with no explanation. Billing companies that process and move on. The average surgical practice loses six figures a year to these patterns—and most never see it happening.
30% of surgical cases are initially denied. The average practice spends 13+ hours per physician per week on prior auths—and 82% of appeals that get filed are overturned. Most never get filed.
Payers auto-reduce your claims without notice and wait for you to appeal. You have to prove you billed correctly—they don't have to prove you didn't. Most practices either can't afford to fight it or don't know it's happening.
65% of denied claims are never reworked. For surgical practices, each abandoned denial is $5K–$30K gone. Most billers process and move on. We don't.
Out-of-network cases involve the largest fees—and the most aggressive payer pushback. Timing, persistence, and a clear negotiation strategy are the difference between the offer and what the case is actually worth.
Payers routinely pay below your contracted rates. Without comparing every EOB against your fee schedule line by line, you'll never catch it. Most billing companies don't do this. We do it automatically.
The difference between a 99213 and 99214 is $40–80 per visit. Across thousands of visits, undercoding is six figures a year—invisible until someone looks for it.
Physicians consistently rate their billing companies as one of their top frustrations. Claims get submitted. Denials get written off. Underpayments go uncontested. Nobody is looking at the whole picture—tracking every denial through every level of appeal, catching payer patterns, or pushing back the way the case deserves.
Evident was built by a practicing surgical subspecialist who has lived every one of these problems firsthand. Our free Revenue Architecture Review analyzes 90 days of your claims data and shows you exactly what's being left on the table.
Get Your Free ReviewI've done peer-to-peer reviews on the morning of a scheduled case. I've watched a payer automatically downcode a complex surgical procedure with no explanation. I've seen billing companies accept that and move on. That's why I built Evident—because surgeons deserve someone who fights as hard for their revenue as they fight for their patients.
Anupam Pradhan, MD — Founder & CEO · Board-Certified Orthopedic Surgeon · Chair of Orthopedics, Medical City Dallas
Every Evident client gets a live Revenue Intelligence Dashboard. No more unread monthly reports. You see every claim, every denial, every dollar—in real time.
| Payer | 0-30 Days | 31-60 Days | 61-90 Days | 90+ Days | Total | % of A/R |
|---|---|---|---|---|---|---|
| UUHC | $52,400 | $38,100 | $22,600 | $31,200 | $144,300 | 35.0% |
| BBCBS | $64,200 | $18,400 | $8,300 | $6,100 | $97,000 | 23.5% |
| AAetna | $41,800 | $15,200 | $9,400 | $18,930 | $85,330 | 20.7% |
| CCigna | $28,600 | $12,300 | $7,150 | $8,400 | $56,450 | 13.7% |
| ★ Medicare | $11,400 | $6,800 | $3,800 | $2,600 | $24,600 | 6.0% |
| Total | $198,400 | $90,800 | $51,250 | $67,230 | $412,680 | 100% |
| Patient | Payer | CPT | Billed | Reason | Status | Stage | Progress |
|---|---|---|---|---|---|---|---|
| M. Johnson | UUHC | 63685 | $28,400 | Medical necessity | Appealing | Appeal L2 | |
| R. Chen | AAetna | 64635 | $22,100 | Prior auth missing | Appealing | Appeal L1 | |
| A. Martinez | UUHC | 27279 | $19,200 | Bundling error | Appealing | Appeal L3 | |
| T. Williams | CCigna | 63685 | $18,750 | OON dispute | Recovered | IDR | |
| L. Park | BBCBS | 62323 | $15,800 | Underpayment | Appealing | Appeal L1 | |
| K. Patel | UUHC | 64636 | $8,900 | Timely filing | New Denial | New |
Six capabilities working together. Each one generates measurable revenue your current biller is leaving behind.
Full workflow — submission, tracking, peer-to-peer coordination, and appeals. Your staff stops spending their day on hold. 30% of surgical cases get initially denied; we make sure every one gets properly fought.
Every denial appealed through all three levels. Aged A/R reworked. Nothing written off until every avenue is exhausted — including IDR when warranted. We track every claim until it closes.
Every EOB compared against your contracted rates daily. Underpayments flagged automatically. OON cases negotiated through every available channel — including MultiPlan pushback and federal IDR.
Modifier optimization, documentation alignment, and coding accuracy reviews. AI-powered alerts catch payer patterns and underpayment trends before they compound. Every client gets a live dashboard — not a monthly PDF.
It's not. We handle the full transition. Here's exactly how it works.
Most practices we review are owed significantly more than they realize—in abandoned denials, systematic underpayments, and prior auths that were never appealed. The free Revenue Architecture Review takes 90 days of your claims data and shows you exactly what's there. No obligation. Just the number.
The free Revenue Architecture Review takes 90 days of claims data and shows you the exact dollar amount being left behind. Most practices are surprised by what they find.