Pediatric OT · Speech · PT Revenue Recovery

Revenue intelligence
built for pediatric therapy.

Griffin RevCore helps pediatric OT, Speech, and PT clinics organize denial recovery workflows, generate structured payer-facing documentation, and track revenue recovery from intake through resolution.

Schedule a Demo See the Difference
Built on live Ensora claims data
Structured denial workflows
Pilot-based engagement model
Griffin RevCore · Live Case
CASE-0084 · Pediatric Therapy Clinic
Med Necessity Confidence 94%
$4,250
Generated Appeal · CPT 97760 · BCBS
The clinical record supports continued skilled intervention with documented functional progression, measurable therapeutic response, and ongoing treatment necessity aligned to the patient's active plan of care...

Additional clarification regarding the basis for the determination has been requested to support appropriate review and adjudication of the submitted claim documentation...
7+ Denial types
A+ Appeal grade
24/7 Workflow visibility
Medical Necessity · Authorization Mismatch · Timely Filing · CO16 / M76 Corrected Claims · PR96 / N569 Diagnosis Coverage · Overpayment Recoupment · Expired Referral · Bundling Disputes · Medical Necessity · Authorization Mismatch · Timely Filing · CO16 / M76 Corrected Claims · PR96 / N569 Diagnosis Coverage · Overpayment Recoupment · Expired Referral · Bundling Disputes ·
The Problem

Your billing team knows money is walking out.
They just can't chase all of it.

Pediatric therapy clinics face a painful reality: high denial rates, payer-specific rules that change constantly, and billing staff stretched thin. The denials pile up — and most never get appealed.

📋

Denials pile up unanswered

Low-dollar denials get written off. Medium-dollar ones sit aging. High-dollar ones get inconsistent manual appeals. Revenue leaves every week without a fight.

🧩

Generic tools miss payer logic

EHRs flag denials. Clearinghouses pass claims. Neither builds the payer-specific, CPT-specific argument that actually wins on appeal. That gap is your lost revenue.

📊

No visibility into recovery

Without structured tracking from denial intake through resolution, you can't see true revenue at risk — or prove what your team has actually recovered.

Auth Authorization, referral, unit, CPT, and provider mismatches create preventable A/R work
Code CO16, M76, diagnosis, and corrected-claim issues often need structured cleanup
Med Medical necessity denials require clinical evidence, not generic reconsideration language
Track Every denial should connect to status, follow-up action, outcome, and recovered revenue
See the Difference

Generic appeal vs.
governed adjudication.

Most billers send the same letter for every denial. Griffin RevCore builds the exact argument each denial requires — payer-specific, CPT-specific, doctrine-backed.

Standard Appeal

Dear Payer,

We are requesting reconsideration of the denial for the above-referenced claim. The services provided were medically necessary and appropriate for this patient.

Please review the attached documentation and reconsider this claim for payment.

Thank you for your time and consideration.

No specific criterion challenged. Low overturn probability.
Griffin RevCore Output

Dear Blue Cross Blue Shield,

The submitted documentation reflects measurable therapeutic progression, continued skilled treatment involvement, and ongoing functional communication deficits requiring active intervention.

The current determination does not appear to address the documented progression, therapeutic response, or ongoing skilled treatment requirements reflected in the submitted record.

Please review the attached documentation and reconsider the claim based on the submitted clinical findings, plan of care, and documented functional response to therapy.

Specific clinical findings challenged with structured payer-facing review posture.
Standard Appeal

Dear Payer,

We are appealing this authorization denial. The services were authorized and clinically appropriate for this patient.

Please review your records and reprocess this claim for payment at your earliest convenience.

No auth number cited. No resolution pathway requested.
Griffin RevCore Output

Dear Cigna,

The denial appears connected to authorization alignment, CPT linkage, or claim configuration requirements associated with the billed therapy episode.

Griffin RevCore separates operational authorization defects from clinical necessity review and organizes the case into a structured administrative workflow for payer follow-up.

The workflow maintains authorization visibility, supporting documentation organization, and payer-response tracking throughout the review process.

Operational defect isolated and routed into structured payer-resolution workflow.
Typical Response

Dear Payer,

We have received your overpayment request. We are reviewing our records and will respond accordingly.

Please allow time for our review. We will contact you if we have questions.

No rights invoked. No collection halted. Payment likely remitted.
Griffin RevCore Output

Dear Luminare Health,

Griffin RevCore organizes overpayment and recoupment disputes into structured review workflows with centralized documentation and timeline tracking.

The platform maintains organized payer correspondence, review sequencing, and dispute-status visibility throughout the recovery process.

Administrative review activity, supporting records, and follow-up actions remain connected within a single case workflow from intake through resolution.

Centralized recoupment workflow established with structured dispute tracking.
Griffin Professional Solutions
Griffin Professional Solutions
Home of Griffin RevCore
The Platform

Not a template library.
A structured revenue intelligence platform.

RevCore classifies each denial, routes it to the correct strategy, and generates structured appeals aligned with how claims are actually adjudicated. Every case tracked. Every dollar attributed.

01

Medical Necessity

Structured clinical review workflows designed for pediatric therapy denials requiring organized documentation and payer-facing support.

02

Authorization Denials

Authorization and referral denials routed into structured administrative workflows aligned to the operational issue identified within the claim.

03

Corrected Claim (CO16/M76)

Corrected-claim and missing-information workflows organized separately from clinical review pathways for clearer payer handling.

04

Diagnosis Coverage (PR96/N569)

Diagnosis coverage and policy-related denials routed into structured review workflows with supporting documentation organization.

05

Overpayment Recoupment

Structured overpayment and recoupment review workflows with organized documentation and payer-response management.

06

Timely Filing

Timely filing workflows organized around submission history, documentation review, and payer follow-up management.

07

Duplicate & Bundling

Duplicate and bundling-related denials organized into structured administrative review workflows for operational follow-up.

08

Revenue Tracking

Every case tracked from intake through resolution. Dollars tied to each appeal. See revenue at risk, recovery performance, and real outcomes.

Built On Real Data

Built around real pediatric therapy denial workflows.

Griffin RevCore was developed using real pediatric therapy denial patterns, payer responses, and operational billing workflows observed inside active clinics. The platform is designed to align quickly with existing denial processes while supporting a structured onboarding and calibration phase for each clinic environment.

See It With Your Claims
How It Works

From denial to recovered revenue
in four steps.

01

Upload the denial

Submit the EOB or denial letter, claim details, payer, CPT code, and date of service. No EHR integration required — works alongside your existing Ensora or any billing workflow.

02

RevCore classifies the denial

The engine identifies the denial type and routes it to the correct strategy path — appeal, corrected claim, or recoupment dispute — then selects the appropriate doctrine framework.

03

Generate a structured appeal

For medical necessity denials, enter structured clinical evidence. The engine produces a payer-specific, CPT-specific appeal with the correct adjudication posture for the denial type and payer.

04

Track outcomes and revenue

Monitor every case from submission through resolution. See recovered dollars, revenue at risk, and performance by denial type and payer — in one place.

Griffin RevCore · Case Detail
CASE-0078 · Pediatric Therapy Clinic
$4,250
CPT 92507 Blue Cross Blue Shield Med Necessity Confidence 94%

Dear Blue Cross Blue Shield,

The submitted documentation supports continued skilled therapy intervention with measurable clinical progression and ongoing treatment necessity aligned to the patient's active plan of care.

Functional communication improvements and documented therapeutic response support continued review of the submitted services and associated documentation.

RevCore organized the denial into the appropriate clinical review workflow and generated structured supporting documentation for payer reconsideration.

About Griffin RevCore

Revenue intelligence built for the operational reality of pediatric therapy billing.

Griffin RevCore was created by Griffin Professional Solutions to solve a growing operational problem inside pediatric therapy revenue cycle management: denials were increasing, workflows were fragmented, and most systems stopped at claim submission instead of true denial resolution.

Griffin RevCore was built specifically for pediatric OT, Speech, and PT clinics that need more than generic billing software or template appeal letters. The platform organizes denial workflows, structures payer-facing documentation, and helps clinics track recovery activity across authorization denials, corrected claims, timely filing issues, medical necessity reviews, diagnosis coverage disputes, and recoupment workflows.

Our focus is simple: help pediatric therapy clinics recover revenue that is often delayed, written off, or never appealed at all.

Pricing

Performance-aligned pilot engagements.

RevCore is implemented through structured pilot engagements designed around denial volume, operational workflow, and recovery objectives. Pricing is customized based on clinic size and workflow complexity.

Pilot Engagement
Structured

Designed for pediatric therapy clinics evaluating denial recovery infrastructure and workflow improvement.

  • 5-case calibration workflow
  • 90-day pilot engagement
  • Payer-specific appeal generation
  • Structured denial tracking
  • Revenue recovery reporting
  • Operational workflow review
Request Pilot Review
Ongoing Partnership
Custom

For clinics requiring scaled denial intelligence, expanded reporting, and multi-location operational support.

  • Expanded denial workflow coverage
  • Multi-location visibility
  • Priority operational support
  • Recovery analytics and reporting
  • Workflow optimization guidance
  • Ongoing platform alignment
Discuss Pricing
Get Started

See what Griffin RevCore does with your actual denials.

Submit a few details about your clinic. We'll run a free 5-case calibration so you can see exactly what RevCore produces before any commitment.

Built around real denial workflows
RevCore was shaped using real pediatric therapy denial workflows and includes a structured calibration phase to align with each clinic’s operational environment.
No PHI in this form
Initial contact only. Any claim review happens through a secure, clinic-specific workflow.
Pediatric therapy only
Focused on OT, Speech, and PT denial recovery — not generic healthcare billing.

Do not include patient names, DOBs, member IDs, or other PHI in this form.