Appeals worth filing. Citations that check out. Deadlines that don't slip.
Lysco is software that reads denials and medical bills, tells your team honestly which ones are worth fighting, and drafts the appeal or dispute for your staff or member to review and send.
Who it's for
For teams that carry the cost when a denial stands.
Drug manufacturers and hub vendors
Patient-access and hub teams supporting specialty therapies.
The cost you carry: A denied specialty prescription is a therapy start that does not happen until someone appeals it well and on time.
TPAs and brokers for self-funded plans
Bill review for self-funded employer health plans.
The cost you carry: In a self-funded plan, an overpaid hospital bill is paid out of the plan’s own money.
Navigation and advocacy vendors, and union health funds
Navigation and advocacy services, and Taft-Hartley (union) health funds.
The cost you carry: Advocates’ time is the cost base. An hour spent on an appeal the documents do not support is an hour taken from one they do.
Medicaid plans, health centers and financial counselors
Medicaid health plans, community health centers and hospital financial counselors.
The cost you carry: Members lost to paperwork mean lost coverage. Federal law requires states to begin Medicaid community-engagement (work) rules for specified adults on January 1, 2027, unless a state starts sooner. A coverage-keeping pilot can run before then.
What the engine does
From the document to a draft your team can send.
Step 1
A denial or a bill goes in
A denial letter, an explanation of benefits, or a medical bill, as a PDF or a photo.
Step 2
An honest verdict comes out
Whether the documents support a fight, and why.
- For a denial: an argument-strength score from 0 to 100, the deadline quoted from the notice for your staff to confirm, and the appeal route for the plan type, whether employer (self-funded or fully insured), Marketplace, Medicare Advantage or Medicaid.
- For a bill: the charges worth questioning, and the reason for each.
Step 3
A verified draft follows
When the documents support a case, Lysco drafts the appeal or dispute, with every citation independently checked. Your staff or the member reviews it, signs it and sends it.
The score rates the strength of the written argument. It is not the odds that a payer reverses its decision.
Lysco is software. It does not submit, send, negotiate or represent anyone. Your organization or the member decides what to send, and sends it.
Why the honest verdict matters
Knowing which appeals not to file is half the work.
It screens out appeals that are not worth filing
Cases the documents do not support are set aside before anyone drafts a letter, so staff time goes to the cases the documents do support.
It keeps your credibility with payers
The appeals that go out are the ones the documents back, with citations that check out and a deadline your staff have confirmed.
It is the same engine consumers use
Your team sees the same verdict a consumer gets from Lysco. When the documents do not support a case, it says “no case” and explains why, instead of drafting a letter anyway.
How a pilot works
A pilot on your own past denials.
You send de-identified past denials with outcomes you already know.
We run the same analysis consumers get.
You get a report on verdict accuracy against your known outcomes, and time per case.
It takes about 2–4 weeks.
No patient identifiers are needed for the pilot. The report shows where the verdict matched your known outcomes and where it did not. It is a measurement of past cases, not a promise about future ones.
Security and privacy
Your security review comes first.
We'll work through your security review before any records are shared, and the pilot uses de-identified records only. The controls Lysco runs today are described on our Security and Trust Center pages.
Next step
Request a pilot
Tell us where to reach you and what kind of organization you are. We'll reply by email to plan a pilot on your own past denials.
Lysco is informational software, not a law firm, medical provider, insurer or licensed patient advocate. It does not submit, send, negotiate or represent anyone; your organization or the member reviews and sends anything Lysco prepares. Results depend on each plan, document and case. This page is not medical or legal advice.