Public proof needs a visible denominator.
Insurf publishes appeal outcomes only with denominator definitions, case-selection caveats, payer and specialty mix, physician attestation status, source snapshot rules, and small-n suppression.
What enters each metric.
Public proof is useful only when the reader can reconstruct the count. Insurf keeps draft, submitted, attested, resolved, and recovered-dollar denominators separate.
Appeal packets delivered to a payer or delegated reviewer by the practice or an approved submission partner, with proof recorded in Inveto.
Drafts, duplicate uploads, test cases, and packets returned before payer receipt.
Submitted appeals with a recorded treating physician or supervising medical director attestation before submission.
Appeals routed for review but not signed, operational edits made after attestation, and non-clinical signoffs.
Submitted appeals with documentary evidence of a final payer response, payment event, withdrawal, or administrative closure.
Pending appeals, verbal updates without source evidence, and claims still inside the payer response window.
Full overturns plus partial overturns divided by resolved outcomes, not divided by all submitted appeals.
Pending appeals remain visible in volume counts but never enter the overturn denominator.
Allowed, paid, or credited dollars tied to a resolved full or partial overturn and supported by remittance, EOB, or payer letter.
Submitted charge amounts, estimated future collections, and unresolved expected value.
Resolution categories stay explicit.
Full overturn
IncludedThe payer reverses the denial for the requested item, service, or drug and approves payment or coverage.
Partial overturn
IncludedThe payer approves a narrower period, lower quantity, alternate code, or partial payment tied to the appealed denial.
Upheld
ExcludedThe payer maintains the denial after review and issues a final adverse response for the appeal level tracked.
Administrative closure
ExcludedThe appeal closes because of eligibility, duplicate claim, missing authorization, timeliness, or routing defects.
Withdrawn
ExcludedThe practice withdraws the appeal or replaces it with a different workflow before a payer merits response.
Pending
Not in denominatorA submitted appeal is inside the response window or awaiting final documentary evidence.
Pilot data has a case mix.
Early data should be read as operational proof from selected specialty practices, not as a random sample of all denied claims.
Case-selection caveats
- Early pilots overrepresent high-value specialty denials where practices already believe the medical record is strong.
- Practices may send denials that staff could not resolve through ordinary follow-up, so samples are not random claim populations.
- Payer mix can shift quickly by geography, employer contracts, and delegated utilization management vendors.
- Specialty mix affects recoverability. Oncology infusion, GI biologics, and imaging denials should not be pooled without showing mix.
Payer mix shown on public dashboards
Specialty mix shown on public dashboards
The audit trail is part of the claim.
Insurf can show aggregate outcomes without exposing patient details because the private record keeps the evidence chain intact.
- Original denial letter, appeal level, receipt date, and payer tracking number.
- Clinical facts used in the appeal, with patient identifiers removed from public surfaces.
- Payer policy, medical necessity guideline, compendium, LCD, NCD, or label snapshot cited by the draft.
- Generated appeal text, final submitted appeal text, and attestation event.
- Final payer response, remittance, EOB, payment evidence, or closure document.
Physician attestation
The treating physician or supervising medical director reviews the appeal packet and attests before the case is counted as physician-attested. Public dashboards report the count and rate, not physician names.
Small-n suppression
Cells with fewer than 11 cases are suppressed or combined. Public views round percentages, bucket rare payer and specialty cells, and avoid cross-tabs that could identify a practice or patient.
Exact public claims.
The claim boundary is as important as the number. These are the statements Insurf will make from pilot proof, and the statements it will not make.
Insurf will claim
- For the displayed sample period, Insurf submitted the shown number of appeals through pilot practices.
- The reported overturn rate is full plus partial overturns divided by resolved outcomes.
- The public dashboard shows payer mix, specialty mix, unresolved volume, and suppression notes next to the headline metrics.
- Each counted physician-attested appeal has an attestation event recorded before submission.
- Every cited appeal stores the source snapshot used at drafting time, including policy version where available.
Insurf will not claim
- Insurf will not claim a payer acted improperly unless the source documents support that statement.
- Insurf will not claim market-wide representativeness from pilot data.
- Insurf will not claim causal lift without a comparator or pre-specified study design.
- Insurf will not publish patient-level outcomes, protected health information, or practice-identifying cells.
- Insurf will not guarantee payment, approval, or clinical appropriateness. The treating physician owns the clinical judgment.