Revenue integrity for independent medical practices
See every claim your billing reports leave behind.
Krino Health provides independent oversight for outsourced medical billing. We turn an export from your practice management system into a prioritized worklist of denied, underpaid, and untouched claims — showing what happened, what to do next, and who needs to act.
Your biller runs the billing workflow. Krino Health gives your practice an independent view of the outcome.
Book a 20-minute call →No pitch — we’re learning how practices handle denials today.
Your reports show the fee, not the missed revenue.
If you outsource billing, an invoice and a monthly summary are usually the clearest documents you receive. They show what you paid and how much was collected — but not the claims that never turned into revenue.
| # | Description | Total |
|---|---|---|
| 47 | Patient Statements Paid | $4,210.55 |
| June 2026 Billing Services | $118,463.90 | |
| June 2026 Billing Credit | ($612.40) |
| Charges submitted | $214,880 |
| Insurance payments | $118,464 |
| Adjustments | $38,190 |
| Patient balance | $11,720 |
| Net collection rate | 93.8% |
93.8% reads well, and it’s meant to. But different outcomes — contractual write-offs, denials no one worked, claims that ran out of time, payments that came in short — get compressed into a few aggregate lines. You still can’t see which claims are recoverable, or whether anyone followed up.
Denial totals help, but they still don’t show the next action.
| CO-16 Claim lacks information or has a billing error | 22 claims | $4,180 |
| CO-97 Benefit included in another service’s payment | 14 claims | $2,740 |
| CO-50 Not deemed medically necessary | 8 claims | $3,920 |
| CO-22 Coordination of benefits | 7 claims | $2,020 |
| PR-31 Patient cannot be identified as our insured | 6 claims | $1,610 |
| CO-197 Precertification / authorization absent | 4 claims | $3,690 |
| 61 claims | $18,160 |
Better. You now know what went wrong. You still don’t know which claims, whether anyone has touched them since, how much time is left, or which ones need you rather than your staff.
A claim-level worklist, prioritized by urgency.
Every claim with money still on it, sorted by how much time is left. Filter by the kind of work it needs, or by who has to do it. Open any row to see the whole life of the claim — when it went out, when the payer answered, when the money posted, and how long it has been sitting since.
| › Okafor, D. | 02/27/2026 | 99215 | Medicare | $186.00 | — | Denied | Documentation didn’t support the level billed | Appeal · clinical | Physician | Open · untouched 134d | EXPIRED |
| › Ibrahim, R. | 03/20/2026 | J1100 | Medicare | $41.30 | — | Denied | Billed without the qualifying service it attaches to | Resubmit | Biller | Open · untouched 112d | 9 days left |
| › Brooks, S. | 03/09/2026 | 96372 | BCBS | $13.70 | — | Paid short | Payer allowed $42.10 and posted $28.40 | Underpaid | Biller | Open · untouched 126d | 49 days left |
| › Whitfield, J. | 04/02/2026 | 99396 | Cigna | $224.00 | — | Denied | Payer says another plan is primary under coordination of benefits | Eligibility | Front desk | Open · untouched 109d | 68 days left |
| › Sorensen, K. | 04/24/2026 | 99214 | UnitedHealthcare | $156.00 | $30.00 | Rejected | Procedure code inconsistent with the modifier used | Recode | Coder | Open · untouched 105d | 71 days left |
| › Alvarez, M. | 05/02/2026 | 99214 | Aetna | $142.00 | $35.00 | Rejected | Claim lacks information — referring provider NPI missing | Resubmit | Biller | Open · untouched 97d | 79 days left |
| › Chen, R. | 04/18/2026 | 20610 | UnitedHealthcare | $178.40 | — | Denied | Injection folded into the payment for the office visit; modifier 25 absent | Recode | Coder | Open · untouched 92d | 84 days left |
| › Nguyen, T. | 05/11/2026 | 73721 | Cigna | $412.00 | — | Denied | Precertification absent for the MRI | Appeal · admin | Biller | Open · untouched 61d | 116 days left |
| › Duarte, C. | 05/15/2026 | 97110 | BCBS | $65.00 | $20.00 | Denied | Payer deems the information submitted does not support this many sessions | Appeal · clinical | Physician | Open · untouched 60d | 117 days left |
| › Rivera, L. | 05/22/2026 | 99213 | Medicaid | $96.00 | — | Denied | Payer cannot identify the patient as its insured on that date | Eligibility | Front desk | Open · untouched 53d | 123 days left |
| › Haddad, N. | 05/29/2026 | 20605 | Aetna | $88.20 | $25.00 | Denied | Injection called not medically necessary at this frequency | Appeal · clinical | Physician | Open · untouched 46d | 131 days left |
| › Patel, A. | 11/14/2025 | 20611 | Aetna | $205.60 | — | Reversed | Paid in January, then reversed in June after a retroactive review | Appeal · admin | Biller | Open · untouched 42d | 134 days left |
| › Lindqvist, P. | 04/09/2026 | 99213 | Aetna | $118.00 | $25.00 | Paid | NPI corrected and resubmitted; paid in full | Resubmit | Biller | Closed 06/18/2026 | Closed |
| › Osei, F. | 03/30/2026 | 20610 | Cigna | $165.50 | — | Paid | Modifier 25 added on resubmission | Recode | Coder | Closed 05/29/2026 | Closed |
| › Marsh, T. | 02/18/2026 | 99214 | Medicare | $149.00 | — | Paid | Redetermination filed with the office note; denial overturned | Appeal · clinical | Physician | Closed 06/02/2026 | Closed |
Click any row to open the claim. On a narrow screen the table shows fewer columns — the rest are inside the row.
Appeal windows are set by each payer’s contract and vary widely. Shown here: Medicare at 120 days from receipt of the remittance advice (receipt presumed 5 days after the notice date, per CMS); commercial payers illustrated at 180 days from the remittance date. Rejected claims are governed by the timely-filing limit, not an appeal window.
Three things do most of the work. Who acts separates the claims your front desk can close today from the three that need you to write something. Resolved is a column most reports don’t include — untouched 134d means a hundred and thirty-four days have passed since anyone recorded a single action on that claim, and in every report you get today it looks identical to one denied last week. And opening a row shows you exactly where the work should have happened and didn’t.
- Resubmit
- A field is wrong or missing. Correct it and send it again — there’s nothing to argue about and no one to persuade.
- Recode
- The service was payable but not as it was coded. A modifier, a bundling edit, a code that contradicts another line. Needs someone who codes, not someone who chases.
- Eligibility
- The claim went to the wrong plan, or to the right plan on the wrong date. Coordination of benefits, termed coverage, a secondary that should have been primary.
- Appeal · admin
- A real dispute, but a procedural one: authorization that existed and wasn’t attached, timely filing with proof, a recoupment that shouldn’t have happened. Paperwork, not medicine.
- Appeal · clinical
- The payer is disputing the medicine — necessity, frequency, level of service. Winning it takes a clinician who can say why the care was warranted. These are the ones that get abandoned, because they’re the only ones that cost your time rather than your staff’s.
- Underpaid
- Not the contractual write-off. Every claim is billed above the contracted rate on purpose, and the gap between your charge and the allowed amount is a normal adjustment — it was never collectible. This is a different thing: the payer’s own remittance allowed one amount and then paid a smaller one, with nothing on the claim explaining the difference.
A $60 denial isn’t worth the same to everyone.
Most independent practices outsource billing for 4–9% of collections. The arrangement works — until a claim comes back denied.
Reworking a denial costs staff time. Whether that time is worth spending depends entirely on who is counting.
| Recovered value | Cost to rework | Rational move | |
|---|---|---|---|
| Billing company at 6% | $3.60 | ~$25 in staff time | Let it go |
| Your practice | ~$56 | An already-staffed hour | Collect it |
Illustrative arithmetic — assumes a 6% collections fee and roughly $25 of staff time to rework one denial. Actual economics vary by contract and workflow.
Nobody here is acting in bad faith. The incentive simply doesn’t point the same direction for both parties, and the gap between the two rows never shows up in a report — it’s folded into adjustments and stops being visible.
Questions we get.
Krino Health finds and prioritizes the work — it doesn’t file appeals or contact payers on your behalf. Your existing staff or billing team takes the action. What Krino Health changes is visibility: which twelve of the sixty-one claims are worth an hour today, and which three of those need you rather than your staff. It doesn’t add a person; it makes the existing one’s next hour obvious.
No. Krino Health doesn’t replace anything in your billing workflow and doesn’t require your biller to do anything differently. It reads a report you can already export yourself.
No. The data comes out of your own practice management system, under your own login. There’s nothing to ask permission for.
Then the report will show that, and that’s worth knowing too. Most of what Krino Health surfaces isn’t negligence — reworking a $60 denial genuinely costs a billing company more than it earns them. The incentive is structural, not personal.
Not today. What Krino Health reads now is what the payer sent back about claims that were already submitted — nothing about the visit itself. EMR access opens up work further upstream, and it’s on the roadmap, but it isn’t needed to start and won’t happen without you asking for it.
No. Payers will only discuss claims with the provider or a formally designated agent, and Krino Health is deliberately neither. You keep the relationship. We just tell you where to point it.
Most of them, yes — and those are supposed to be there. You bill above every payer’s contracted rate on purpose, so that you never accidentally ask for less than one of them would have paid. The difference gets written off, and it was never money you could collect. Krino Health doesn’t flag any of that. What it separates out is the rest of the line: claims denied for a reason nobody worked, payments smaller than the payer’s own allowed amount, and money that was paid and later taken back.
Not quite. A/R aging tells you what’s outstanding. It doesn’t tell you which claims were denied for a fixable reason, which ones nobody has touched since, which ones are about to run out of appeal time, or which ones can’t be closed without a clinician.
Claim files carry patient identifiers, insurance IDs, and diagnosis codes, so this is PHI and gets handled accordingly, under a BAA. It’s a far smaller surface than clinical records.
See what your billing leaves behind.
We’re talking with practice owners about how denials actually get handled — no pitch, nothing to buy.