Now accepting early access partners

Stop writing off denied biologic claims.

Upload a denial. Get a complete, evidence-backed appeal packet — with payer-specific arguments, clinical citations, and documentation — in under 5 minutes. Submit through your existing portal. That's it.

Get Early Access See how it works
HIPAA-Aligned Architecture
Built for Infusion Centers & Specialty Practices
Works with CoverMyMeds
+$147,200
Recovered Q4
BC
Horizon BCBS
Criteria loaded
Appeal Generation Generating
Denied Drug Remicade (infliximab)
Payer UnitedHealthcare
Denial Type Step Therapy Not Met
Claim Value $6,240
Appeal Argument
This patient has met UnitedHealthcare's step therapy requirements per policy 2024T0234R by trialing and failing methotrexate (25mg/wk × 4 months, discontinued due to hepatotoxicity) and a TNF inhibitor...
Covering the highest-cost infusion therapies
Remicade Entyvio Ocrevus Orencia Actemra Rituxan Tysabri Stelara Soliris Tepezza Benlysta Dupixent Privigen Simponi Aria Remicade Entyvio Ocrevus Orencia Actemra Rituxan Tysabri Stelara Soliris Tepezza Benlysta Dupixent Privigen Simponi Aria
The Problem

Every denied infusion is revenue walking out the door.

Complex denials. Missed deadlines. Manual processes that vary by payer, drug, and specialist. Your team is buried in paperwork — rewriting the same appeals, researching the same payer criteria, losing the same recoverable revenue. Every single week.

25–35%
Biologic claim denial rate
And climbing. Payers are tightening utilization management on high-cost specialty drugs faster than practices can keep up with policy changes.
Sources: MGMA, HFMA
65%
Of denials never appealed
Not because you'd lose. Because your staff can't spend hours researching payer criteria, compiling evidence, and writing a clinical narrative for every single one.
Source: AAPC
$500K–$2M
Annual recoverable revenue
The average specialty practice or infusion center leaves six figures or more on the table every year in denied biologic claims that were never contested.
Based on industry data

"We know we should be appealing more. We know we'd win most of them. We just can't get to them all — so we eat the loss and move on."

— Practice Administrator, 6-physician Rheumatology Group
How It Works

Three steps. That's it.

No blank pages. No googling payer criteria. No guessing which clinical trial to cite. Enter the denial, and InfusionRCM builds the argument.

1
Upload the denial
Drop the denial PDF or enter the details manually. Select the payer, denied drug, and denial type. InfusionRCM loads that payer's specific criteria, documentation requirements, and appeal deadlines automatically.
2
We generate the appeal packet
Evidence-backed letter with medical necessity arguments, step-therapy override reasoning, and payer policy citations. Clinical documentation checklist. Complete packet assembled and ready — in under 5 minutes.
3
Review and submit
Physician reviews and approves. Edit anything you need. Export the complete PDF appeal packet and submit through your existing portal. We track the timeline and deadlines from there.
Platform

Appeal intelligence built for biologics.

Every feature designed around one reality: each payer has different rules, each drug has different criteria, and your staff doesn't have time to be an expert in all of them.

Payer-Specific Arguments
What Aetna requires for Humira in RA is different from what Horizon BCBS requires for Taltz in PsA. InfusionRCM maps each appeal to the exact payer's published coverage criteria.
Clinical Evidence Engine
Automatically references ACR, AGA, AAD, and AAN guidelines, FDA prescribing information, and pivotal trial data. No more researching the right citation at 4pm on a Friday.
Step Therapy Override
Maps your patient's therapy history against the payer's required sequence. Builds the exception argument with contraindication evidence, guideline citations, and state override laws.
Complete Packet Assembly
Not just a letter. A complete appeal submission: cover sheet, payer-specific forms, signed clinical narrative, evidence references, and medical records checklist. Export as PDF.
Deadline Tracking
Every appeal tracked from draft to outcome with urgency alerts. Know what's pending, what's due, and what's been recovered — in real time. Never miss a filing window again.
Revenue Recovery Analytics
See denied revenue recovered by payer, by drug, by denial type. The numbers your administrator needs for quarterly reviews and your billing team needs to prove ROI.
Your Existing Workflow

Works with CoverMyMeds. No changes required.

InfusionRCM doesn't replace your PA submission workflow. It handles what comes after — when the denial lands and your team needs to fight it.

Submission Engine
CoverMyMeds
  • PA intake & submission
  • Form routing
  • Portal access
  • Status checks
Denial
lands
Appeal
starts
Resolution Engine
InfusionRCM
  • Denial ingestion
  • Appeal letter generation
  • Payer policy matching
  • Document packets & deadline management
You keep your current workflow. We handle what comes after the denial.
Your Specialty

Purpose-built for the practices hit hardest.

InfusionRCM covers the biologics, payer criteria, and clinical guidelines specific to your therapeutic area — because a generic denial tool doesn't know the difference between a DAS28 score and a Harvey-Bradshaw Index.

Rheumatology
60–70% of your revenue depends on biologics. Payers know it.
Step therapy gauntlets. TNF-failure requirements before IL-17 or IL-23 access. Retrospective medical necessity denials on established infusion patients. InfusionRCM maps every argument to ACR guidelines, SPIRIT/SELECT/OPAL trial data, and each payer's specific RA, PsA, and AS criteria.
Remicade Orencia Actemra Humira Enbrel Cosentyx Taltz Rinvoq Kevzara
Gastroenterology
A denied Remicade infusion is $6,000 in drug cost you've already absorbed.
IBD patients cycling through step therapy while their disease progresses. Payers demanding TNF trials before vedolizumab despite TB risk. InfusionRCM cites AGA guidelines, SONIC/UNIFI/GEMINI data, and builds the medical necessity case specific to Crohn's and UC biology.
Remicade Inflectra Entyvio Stelara Skyrizi Cimzia Rinvoq
Dermatology
Your PA coordinator shouldn't need to know every payer's PASI threshold by heart.
Psoriasis and atopic dermatitis biologics face aggressive formulary management and non-medical switching mandates. InfusionRCM handles formulary exceptions, step therapy overrides, and medical necessity arguments mapped to AAD guidelines and VOYAGE/IXORA/MEASURE trial evidence.
Dupixent Skyrizi Tremfya Cosentyx Taltz Stelara Otezla
Neurology
Aggressive MS requires aggressive advocacy. Not a generic template.
High-cost MS therapies and myasthenia gravis biologics face some of the strictest utilization management in specialty medicine. InfusionRCM builds payer-specific arguments for B-cell therapies, complement inhibitors, and FcRn antagonists using AAN guidelines and pivotal trial evidence.
Ocrevus Tysabri Kesimpta Rystiggo Soliris Uplizna
Why InfusionRCM

Built by someone who's been in the room.

InfusionRCM was created by a specialty pharmaceutical professional with over 15 years of experience working directly with the practices and infusion centers this platform serves — navigating payer barriers, supporting prior authorizations, and watching recoverable revenue disappear because the appeal process was too slow, too manual, and too generic.

This isn't a tech company guessing at healthcare. It's deep domain expertise in biologic access, payer navigation, and clinical reimbursement — delivered through purpose-built technology.

25+
Biologic medications
with full criteria coverage
All major
Commercial & government
payer rules mapped
100+
Clinical trial & guideline
references structured
15+ yrs
Specialty pharmaceutical
domain expertise
Founding Partners
Early access. Priority support. Locked-in rates.
We're onboarding a limited number of founding partners who want to stop writing off denied biologic claims. Founding members get priority support, direct access to the product team, and permanently locked-in pricing as InfusionRCM scales.
  • Full payer rules engine — all major commercial & government payers
  • Clinical evidence library — guidelines, trial data, FDA citations
  • Appeal tracking, deadline management, revenue analytics
  • Peer-to-peer preparation briefs
  • No long-term contracts · No setup fees · Cancel anytime
Apply for Early Access Talk to Our Team
The math
1 infusion
One recovered Remicade infusion covers months of InfusionRCM.
A single denied Remicade infusion is $4,000–$8,000 in drug cost your practice already absorbed. Most practices have 20–60+ biologic denials per month. The ROI isn't a question — it's arithmetic.
Frequently Asked

Questions

No. CoverMyMeds handles PA submission — getting the request to the payer. InfusionRCM handles what happens after the denial comes back. We're the resolution engine that generates the appeal packet, builds the clinical argument, and tracks the outcome. They work together, not instead of each other.
No. Keep submitting PAs exactly how you do today. When a denial comes in, you bring it to InfusionRCM. Upload the denial, enter clinical details, and the platform generates your appeal. Then you submit the appeal through your existing portal — CMM, payer website, fax, whatever your current process is.
InfusionRCM covers 25+ biologic medications across rheumatology, gastroenterology, dermatology, and neurology — including Remicade, Entyvio, Ocrevus, Orencia, Actemra, Stelara, Dupixent, Humira, Cosentyx, Taltz, and more. Payer rules are mapped for all major commercial insurers (UHC, Aetna, Cigna, Anthem, Horizon BCBS, Humana, etc.) plus Medicare and Medicaid.
Generic denial tools (Waystar, Change Healthcare, Experian) handle all claim types across all of healthcare. They're broad. InfusionRCM is purpose-built for biologic drug denials — with payer-specific coverage criteria, clinical evidence libraries mapped to specialty guidelines (ACR, AGA, AAD, AAN), and appeal templates designed for the exact denial types that hit infusion practices hardest: step therapy, medical necessity, formulary exception, and site-of-care.
We're onboarding early access partners now. Founding members get priority access to the platform as it launches, direct access to the product team, and permanently locked-in pricing. Apply for early access to secure your spot.
InfusionRCM is built with HIPAA-aligned architecture from the ground up. All patient data is encrypted in transit and at rest. We will execute a Business Associate Agreement (BAA) with every partner practice before any PHI is processed.

Your biologics are getting denied.
Your revenue is walking out the door.

Every week you wait is another stack of denied claims that never get appealed, another $50,000 in recoverable revenue written off, and another patient waiting for treatment they need.

Apply for Early Access Talk to Our Team