92% of appeals won at 1/4 the cost

Clicks works with a New Jersey orthopedics group on the appeal that follows a denied Personal Injury Protection precertification. Until the denial is answered, the treatment waits. The agent reads the denial, rebuilds the clinical record behind the requested treatment, and hands back a finished appeal package the same day for the team to review and submit.

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Appeal package

Appeal rationale letterDrafted

NJ PIP pre-service appeal formDrafted

Original APTP

Denial letter

Uploaded to the EHR and assigned to the case owner

Win more appeals with less work

Appealing manually

$20

per appeal

68%

of appeals won

25-40 min

of work per appeal

Appealing with Clicks

per appeal

92%

of appeals won

5 min

of work per appeal

Clicks takes the existing documentation and returns a complete appeals package

The payer faxes the denial and a staff member assigns it to the agent. Everything between that and the team's same-day review is the agent reading the file and building the package.

Watch a Clicks AI agentwork the clinical record

Appeals and precertifications draw on the same evidence. Here the agent gathers patient information and supporting documentation from the EHR and creates the entire APTP submission, the request that comes before the denial.

eClinicalWorks demo using fictional patient data in a test environment.

The impact

Every denial is now appealed. The work per appeal fell from 25 to 40 minutes to about five, taking the cost from roughly 20 dollars to 5. The success rate went up at the same time, from 68 percent to 92 percent. The packages win more often because each one arrives with the clinical history assembled the way a medical necessity denial has to be answered. The team's remaining job is the one that needs a person: reading the draft, confirming it reflects the care given, and submitting it to the payer.

92% of appeals won

Up from 68% before the agent

$5 per appeal

Down from about $20 of staff time

5 min per appeal

Down from 25 to 40 minutes of work

Questions about appealing PIP denials

How does an AI agent appeal a New Jersey PIP denial?

A staff member uploads the faxed denial to the EHR and assigns it to the Clicks agent. The agent extracts the denied treatments and the payer's stated reasons, retrieves the original Attending Provider Treatment Plan, completes the New Jersey PIP pre-service appeal form, reads the clinical record from the first visit after the accident forward, drafts a rationale grounded strictly in the notes, and uploads the assembled package back to the EHR for review.

What results does automating PIP denial appeals produce?

The orthopedics group in this story now appeals every denial. Work per appeal fell from 25 to 40 minutes to about five, the cost per appeal fell from roughly 20 dollars of staff time to 5, and the share of appeals won rose from 68 percent to 92 percent.

Does the AI agent submit the appeal to the payer?

No. The agent drafts the complete appeal package and returns it to the EHR the same day. A member of the team reads the draft, confirms it reflects the care that was given, and submits it to the payer.