The product

Every chapter
of the engine.

From the contract to the recovered dollar — how Nuvae works, module by module. Each chapter below is a real workflow, shown the way it runs in the product.

A new category, not another tool

The Recovery Loop.

Prevent, detect, recover — feeding back into each other as one continuous loop, not three disconnected steps.

Not reactive.

Proactive — verified before the claim is submitted, not chased after a denial.

Not single-point.

Layered — three connected layers working as one system, not one bot doing everything.

Not siloed.

Integrated — reads what your RCM already produces, no systems migration.

Not black-box.

Human-reviewable — every recovered dollar traces back to the contract or policy that proves it.

How Nuvae works

Three layers.
One system.

Revenue leaks at three points in the cycle. Nuvae closes all three — as one connected system, not three separate tools.

Layer 1PREVENT

Prevent

Front-end verification

Intercepts eligibility errors and authorization gaps before a claim is ever generated.

Eligibility-related errors drive roughly 1 in 4 initial denials. Nuvae replaces fragmented, manual payer-portal checks with automated verification — cutting routine manual transaction time by 75%.

Layer 2DETECT

Detect

Mid-cycle analytics & matrix compliance

Cross-references 100% of incoming remittance data against multi-tiered contracted rate matrices, in real time.

Payers routinely underpay via quiet system adjustments and proprietary edits. Nuvae's engine catches the micro-leakage human audit teams miss, and maps compliance trends instantly.

Layer 3RECOVER

Recover

Back-end appeal scale & small-balance capture

Deploys generative legal and clinical logic to appeal complex denials and capture unworked balances at scale.

RCM teams write off 60–70% of valid denials to labor shortage alone, abandoning low-balance accounts entirely. Nuvae compresses appeal drafting from hours to minutes — making both high-value exceptions and small-balance claims worth pursuing.

Chapter 01 — Contracts

It all starts with
the contract.

The rates you fought for are buried in PDFs. Nuvae digs them out — and puts them to work.

1–3%of net patient revenue typically lost to contract underpaymentEY RCM Analysis 2026 · HFMA
5–15%of remittances get manually audited against contracted rates todayHFMA Pulse Survey · Advisory Board 2024
35–55%of identified underpayments recovered within 6–12 months of pursuitNuvae deployment observations

Like Drive.
But it reads everything.

Drop in every payor contract. Nuvae classifies it, tracks versions, and never forgets a deadline.

Contract RepositoryAI watching
CLASSIFIED · PPOBlueShield 2026.pdfv4 · 182 pages
RENEWS IN 60 DAYSAetna HMO Master.pdfv2 · 96 pages
2,341 RATES FOUNDUnited Surgical.pdfv7 · 214 pages
AMENDMENT LINKEDCigna Imaging Amd.pdfv1 · 12 pages
ESCALATOR DUEKaiser 2025.pdfv3 · 143 pages
VERSION DIFF READYHumana Renewal.pdfv2 · 88 pages
CLASSIFIED · HMOAnthem South.pdfv5 · 167 pages
TERMS EXTRACTEDMolina Medi-Cal.pdfv1 · 74 pages

Everything a contract team wishes it had

One repository. Four superpowers.

Rate sheets

Create. Manage. Model.

Build rate sheets from any contract. Model a new one before you sign it — and see what it does to revenue.

Knee arthroplasty$21,480
MRI brain w/wo$1,212
Colonoscopy + biopsy$864
Proposed 2027 model+4.2% revenue
Analytics

Your contracts, charted.

Which payor pays best. Which service line leaks. Which contract quietly got worse. One glance.

Best performerUNITED · 98.2% OF RATE
Worst performerBLUESHIELD · 91.4%
Leakiest lineOUTPATIENT IMAGING
Trend vs last quarter+$186K recovered
Reminders

Deadlines find you first.

Renewals, escalators, termination windows, filing limits. Nuvae reads the dates and taps your shoulder in time.

Aetna renewal windowOPENS IN 60 DAYS
Kaiser escalator +3%APPLY SEP 1
Cigna termination notice90-DAY WINDOW
Email + in-appAutomatic
Stale rates

Old rates cost real money.

Rates that haven't moved in years get flagged against today's market and government benchmarks — with the dollar impact attached.

Cardiology panelUNCHANGED 3 YRS
vs Medicare today−11% behind
Annual impact−$412,000
Suggested actionRENEGOTIATE

Stale rate detection

Rates go stale.
Nuvae notices first.

Every rate is checked against time, market, and Medicare. The moment one falls behind, you know what it's costing you.

Rate health · BlueShield PPOScanning
Orthopedic surgery
Updated 2026
$21,480CURRENT
Cardiology panel
Updated 2023
$1,940STALE · −$412K/YR
Outpatient imaging
Updated 2022
$1,212STALE · −$188K/YR
Emergency medicine
Updated 2026
$1,142CURRENT
Lab services
Updated 2024
$48DRIFTING · −$61K/YR

Government rate crawler

Medicare moved.
You already knew.

Nuvae crawls government fee schedules automatically — Medicare, Medicaid, Medi-Cal, TRICARE — and reprices your world the moment they change. No downloads. No spreadsheets. No surprises.

The payoff

All of it adds up to one number.

$0

annual value from contract analytics alone, at a $300M-NPR healthcare provider — mid-path, year one.
Underpayment recovery. Rate negotiation uplift. Analyst time back.

Chapter 02 — The assistant

Not sure which module
has the answer?

One assistant spans every module — contracts, denials, eligibility, claims, rates. If you're unsure where to look, just ask. Every answer shows which tools it used and which page it read. No black box.

Nuvae Assistant28 tools connected
Which BlueShield denials from May are still worth appealing?
appeal_deadlinecontract_termsdenial_search14 denials, $186,420 at stake. Your contract allows 365 days from the EOB — earliest deadline May 12, 2027. 9 score above 0.8 on appealability.Source: BlueShield PPO §7.4, page 82
Draft the top three appeals.
appeal_letterevidence_checkDone. Three letters drafted with contract citations. One is missing an operative note — I've flagged it for upload. Waiting on your approval.

Chapter 03 — Eligibility verification

Verified before the
patient sits down.

Roughly one in four front-end denials starts here. Eligibility used to mean 3–5 minutes per check across payer portals and phone trees — Nuvae's agent calls the payer and checks the portal at the same time, and returns a report in seconds.

Agent one · On the phone

It calls. It waits. You don't.

0:04 Navigated payer phone tree0:31 Member ID + provider NPI given1:58 Coverage confirmed · copay $402:12 Reference number captured
Agent two · On the portal

It checks the portal too.

0:07 Logged in, member located0:19 Benefits page parsed0:26 Prior-auth required: YES — MRI brain
VERIFIED

One report. Both sources. Seconds.

Phone and portal answers reconciled into a single eligibility report — attached to the visit before check-in.

41sportal check
100%documented
~25%of front-end claim denials trace back to eligibility issuesExperian Health 2025/2026
75%of manual eligibility checks removed once verification is automatedNuvae deployment observations
25–40%typical reduction in eligibility-related denials within 90 daysNuvae pilot data 2025–2026

Chapter 04 — Appeal generation

Denied is not
the end.

Fewer than 1 in 3 denied claims is ever appealed — yet properly pursued appeals win 57–82% of the time. The constraint was never the law, it was the hours per letter. Nuvae drafts in minutes, so your team fights the claims that were being written off, not just the big ones.

Denial receivedCO-197 · NO PRIOR AUTH
MRI brain w/wo contrast — $14,208Aetna HMO · claim CLM-77120
Appealability scoreWORTH FIGHTING
Auth was on file — payer error0.87 · PURSUE
Appeal draftedCONTRACT §7.4 CITED
✓ AUTH RECORD✓ CLINICAL NOTE✓ EOB✓ PDR FORM
FILED

Approved by your team, filed with the payer. $14,208 back in play.

30–40%of eligible denials get appealed at most healthcare providers todayCEPR 2025 · JAMA Health Forum 2025
57–82%overturn rate on denials that are properly pursuedHealth Affairs, Jan 2026
5–8×faster letter drafting — 3–4 hours down to 20–30 minutesNuvae pilot deployments 2024–2025

Chapter 05 — The AR agent

It sits on hold.
So nobody else has to.

Unpaid claims age out in phone queues. Nuvae's voice agent works the list all day — dials the payer, asks the questions, documents every answer.

AR follow-up queueWorking
CLM-77120 · AetnaUnpaid 47 days · priority 94$14,208ON CALL
CLM-81554 · UnitedUnpaid 39 days · priority 88$9,640QUEUED
CLM-79302 · CignaUnpaid 61 days · priority 86$7,112QUEUED
CLM-80917 · BlueShieldCalled Jul 2 · recheck Jul 21$18,430SCHEDULED
Live call · 03:42

Aetna provider line

NUVAE Calling about claim ending 7120, tax ID on file.PAYER One moment… that claim is in reprocessing.NUVAE Can I get a reference number and a date?PAYER AET-2260-88413, expect 15 business days.
Reprocessing confirmed · ref capturedRecheck auto-set: Jul 21

Chapter 06 — Claims intelligence

Every claim priced twice.
Before the payer pays once.

Two independent rate engines price every claim against your contract. If they disagree by even a dollar, a human sees it. If the payer disagrees, Nuvae does.

Expected reimbursement · dual engineCross-checking
ClaimEngine AEngine BVerdict
Knee arthroplastyBlueShield PPO · DRG 470$28,904$28,904MATCH
ED visit, high severityAetna HMO · 99285$1,142$1,142MATCH
Cardiac cath, diagnosticUnited · 93458$4,860$4,411→ HUMAN REVIEW
AI SUGGESTIONModifier 59 missing on line 3 — supported by the operative note.+$312
AI SUGGESTIONUncoded secondary diagnosis found in documentation — DRG shifts.+$2,890

Chapter 07 — Rate calculator

Price any service
before you bill it.

Pick a payer contract and a service — Nuvae returns the contracted rate, the Medicare benchmark, and the variance in real time. The same dual-engine model that powers leakage detection and the claims-queue check.

Rate calculatorLive
Contracted rate$21,478
Medicare benchmark$19,850
Variance vs Medicare+8.2%
StatusWITHIN EXPECTED RANGE

CALCULATED BY THE SAME ENGINE USED ACROSS CLAIMS AND LEAKAGE DETECTION

Chapter 08 — Analytics

Type a question.
Get a dashboard.

No report builder. No ticket to the data team. Describe the chart you want, in plain English, and it appears on your dashboard — live.

Widget builderAI
Denial rate by payer · trailing 12 monthsBLUESHIELD OUTLIER — 11.2%

And the rest

Quietly doing their job.

CDI review

Clinical documentation checked against guidelines before coding gaps become denials.

Medical library

Ask across your contracts, Medicare and Medicaid policy, and state regulations — with cited answers.

Payer notifications

Policy and requirement changes from payers, summarized and routed before they bite.

Multi-tenant, from day one

Feature flags and per-tenant configuration let every healthcare provider in a system turn modules on independently.

Security built in

Role-based access on every screen, PHI never written to logs, and a full audit trail on every record touched.

Fits your stack

EDI 835/837, UB-04, FHIR. Nuvae reads the feeds your systems already produce.

HIPAA compliantSOC 2 Type II certifiedEncrypted in transit & at restBAA available on requestRole-based access control

Chapter 09 — The business case

Three modules.
One connected number.

Prevention, detection, and recovery — the full arc of revenue leakage. Eligibility reduces denials entering the system. Contract analytics recovers revenue on claims paid at the wrong rate. Appeals recover revenue on claims that weren't paid at all. Each module is independent and additive.

Indicative annual value · Mid-size healthcare providerMid-path
01 · Eligibility verification$460k – $590k
02 · Contract rate matrix & analytics$1.92M – $2.68M
03 · Appeal generation & tail-end recovery$2.79M – $3.65M
Total annual value$5.17M – $6.92M

Ranges are grounded in observed deployment patterns, not aspirational projections — a starting point for discovery, not a quote. The real number comes from your claim volume, payer mix, and current denial rates.

CAQH Index 2025Experian Health 2025/2026AHA Cost of Caring 2025Advisory Board 2024HFMA Pulse SurveyEY RCM Analysis 2026Health Affairs, Jan 2026JAMA Health Forum 2025

Common questions

Questions healthcare providers ask before they switch.

Does Nuvae replace our existing RCM systems?
No. Nuvae sits on top of the RCM you already run — reading what your systems already produce and adding a layer of verification, detection, and recovery. Nothing gets ripped out.
Which EHR/PMS platforms does Nuvae work with?
Nuvae is purpose-built for US healthcare systems and works with Epic, Cerner, Meditech, and more — via secure API, FHIR, HL7, or file-based integrations.
How long does implementation take?
Deployments are measured in weeks, not years. Most healthcare providers start with a focused pilot on one module before expanding to the full system.
Is Nuvae HIPAA compliant?
Yes. Nuvae is HIPAA compliant and SOC 2 Type II certified, with a signed BAA for every customer. See our Trust Center for the full security and compliance posture.
Is on-premise deployment available?
Yes. Nuvae runs cloud-hosted by default, with an on-premise option available for health systems with strict data-residency or network-isolation requirements.

See your leak.

Send one month of remits and your top three contracts.
We'll return the number. It's yours either way.

Book a walkthrough