RecoupRx · by Baylight
Written off is not the same as lost.
Buy-and-bill clinics lose real revenue to medical-necessity and step-therapy denials that nobody has time to fight. RecoupRx is built to fight them, with clinical argument written the way the payer's own criteria are written, signed by a licensed California pharmacist.
Who this is for
California specialty practices that buy and bill infusions or injectables: retina, community oncology, rheumatology, and their neighbors. A single anti-VEGF, checkpoint-inhibitor or biologic administration bills in the four figures before the visit is counted; Medicare's published ASP pricing file is the reference, and your own remittance is the better one. If your billing team is excellent at claims but stretched thin on clinical appeal letters, that gap is exactly what we fill.
Your manufacturer hub runs benefits checks and prior authorizations on its own drug, and it will not file an appeal on a claim already denied; Genentech Access Solutions says so in writing. The drawer of post-administration denials, across every drug and every payer, is the drawer we work.
How it works
We send the BAA first
One signature, before you send us anything, so nobody on your side has to decide what counts as de-identified. Then you send a line-item export of your denials, exactly as your practice-management system produces it. Sorting is our job.
Pharmacist-led triage, in writing
We read up to 60 denied claims against the payer's own policy and tell you, per claim, which we would file, which need more from the chart, and which we would not file at all, with the reasoning behind each. Weak cases die here, on paper, before anyone signs.
The appeal is drafted and signed
Clinical evidence, guideline citations, and the plan's criteria mapped line by line. A licensed California pharmacist reviews the record and signs the clinical letter under her license. Your prescriber reads and e-signs a one-page attestation from a phone.
Your practice files, we track
The appeal goes out in your name, through the payer's own portal, and we track every dispute window per payer. For plans California regulates, a health plan cannot give you less than 365 days to dispute a claim, contracted or not, and must answer within 45 working days at no charge to you (28 CCR 1300.71.38). Medicare Advantage and self-funded plans run their own clocks.
The payer decides, we report
Recoveries land in your accounts exactly as they always have; we are never the payee and never touch your remittance stream. Every outcome is reported back, win or lose, checked against your own remit, and a claim we lose costs you nothing.
What it costs
The pilot carries no upfront fee. On commercial claims we are paid a fixed percentage of the dollars that actually post to your account on the specific claims we appealed, verified against your own remittance and capped per claim, so on any claim we lose, you pay nothing. Government claims, and any claim resolved by a coding, units or modifier correction rather than a clinical appeal, carry a flat per-appeal fee instead, quoted in writing before anything is filed. Every number is on paper before the first case. Baylight never bills a patient, and no pharmacy is involved.
The audit: up to 60 claims read, up to 20 appeals filed
Within ten business days of complete records you get a written verdict on every claim in the batch, and the two strongest argued in full so you can judge the work itself, not the promise. If a claim we agreed to file is not filed within ten business days of complete records, our fee on that claim is zero, whatever the outcome. We do not put a dollar figure on cases we have not filed.
For the claims you then elect to pursue, up to 20 in the pilot, we build the full packet under the fee terms above: the pharmacist letter, the prescriber attestation, the payer form set, and the deadline tracked, filed by your practice in its own name.
Your staff's part is written down in advance: the denial export, the remit or denial letter, the claim, and the chart note for that date of service, taken exactly as your system exports them. Reading and sorting are ours.
What we never do
- Never touch your remittance stream. Payer money flows to your accounts, untouched, always.
- Never sign a payer form on your behalf. Your practice signs its own waiver of liability; the patient signs their own appointment of representative. We build the packet.
- Never contact your patients. Our client is the practice, full stop.
- Never move PHI without a signed BAA in place.
- Never charge for a case we told you not to file.