Antigen unit counting and biologic auth errors cost allergy & immunology practices recoverable revenue every day.
Allergy & immunology runs immunotherapy, drug, and testing revenue side by side, allergen immunotherapy dose and vial preparation and injection administration, high-cost asthma and urticaria biologics, allergy testing units, and immunodeficiency infusions. A miscounted antigen dose or missing authorization erodes revenue manual teams can't keep up with. Ember catches all of them.
Trusted by specialty groups and health systems
Where allergy & immunology revenue leaks
The denial patterns Ember was built for
Allergy & immunology runs immunotherapy, drug, and testing revenue side by side, and each line has its own denial trap. Antigen unit errors, biologic auth and units, and test-count and medical-necessity gaps compound into systematic underpayment. Ember closes each gap.
01 · Immunotherapy antigen units & administration
Antigen doses billed per vial and mismatched to injection administration codes.
Allergen preparation is billed per dose or vial and paired with single- versus multiple-injection administration, and the smallest unit-count or admin-code mismatch routinely underpays high-volume allergy shots. Ember validates every antigen unit count and injection-administration pairing against payer policy before submission.
95165 · 95115 · 95117 · 9514402 · Buy-and-bill biologics
J-code, unit, and wastage errors on high-cost asthma and urticaria biologics.
Asthma and chronic-urticaria biologics carry high per-dose cost, and the smallest J-code, unit, or wastage-modifier (JW/JZ) error plus a missing prior authorization becomes a denial or takeback on an expensive injection. Ember validates units and documented wastage and confirms authorization before the drug is administered.
J2357 · J0517 · J2182 · JW · JZ03 · Allergy testing units & medical necessity
Unit and medical-necessity denials on high-count testing and IVIG.
Percutaneous and intradermal test counts and immunodeficiency IVIG face strict unit and medical-necessity scrutiny, and documentation gaps deny high-count testing and infusion claims. Ember flags the missing criteria before the service and builds the appeal package when denials occur.
95004 · 95024 · 95044 · J1561Three engines.
One source of truth.
Ember connects clinical documentation, payer policy, and contract terms into a single intelligence layer. Built for the immunotherapy, buy-and-bill biologic, and testing mix allergy & immunology billing spans every day.
01 · Foundation
Data Engine
Bridges the clinical and the financial. Unifies documentation, coding decisions, payer policy, and contracts across every encounter and provider.
R. Okafor
Encounter #A-73118
02 · Audit
Coding Engine
Reviews 100% of encounters against national standards, payer-specific policies, your internal guidelines, and your payer contracts. Every flag carries a rule citation.
Correct antigen units to prepared doses — vial count mismatch
CMS NCCI MUE · confidence 0.96
03 · Recovery
Appeal Engine
Reads CARC and RARC codes, identifies the applicable LCD/NCD policy and contract terms, drafts the appeal letter, packages documentation, and tracks every claim to adjudication.
Re: Claim #A-73118 · Denial CO-50
Omalizumab meets medical-necessity criteria under LCD L34633: documented moderate-to-severe asthma, qualifying IgE level, and failed step therapy, per contract §4.7…
Audit upstream.
Appeal downstream.
Two workflows do most of the work for allergy & immunology practices. The first prevents denials before they happen. The second recovers the ones that slip through.
Pre-bill audit
Catch the antigen unit-count issue before the claim leaves.
Ember reviews every encounter against coding standards, payer immunotherapy and drug policy, and your contracts. Antigen unit and admin-code mismatches, drug-unit and wastage gaps, and medical-necessity issues are flagged before submission.
- 1
Ingest the encounter
Pulls encounter notes, immunotherapy preparation and administration logs, biologic drug administration records, and procedure codes from your EHR and practice management system.
- 2
Validate against rules
Checks antigen unit counts and injection-administration codes, buy-and-bill drug units and wastage, allergy testing counts, and prior-auth status against each payer's specific policies.
- 3
Recommend with citation
Returns the suggested correction tied to the exact payer policy, NCCI edit, or contract term.
- 4
Educate the provider
Coding patterns drive provider-level coaching, so immunotherapy documentation and drug charge capture improve across every clinician.
Correct antigen units + append JZ — vial count, zero wastage
CMS NCCI · confidence 0.97
+23%
Clean-claim rate
100%
Encounters reviewed
+5%
Net collection rate
Automated appeals
Pull. Review. Push.
When a denial occurs, Ember identifies the root cause, retrieves immunotherapy preparation and administration logs, biologic drug administration records, and step-therapy documentation, references payer policy and contract terms, drafts the appeal, and tracks it through adjudication.
Medical necessity
Units/wastage
Admin code mismatch
Drug auth not on file
Omalizumab appeal
-57%
Denial rate
-45%
Cost to collect
+9.3%
Net revenue per appt
The full revenue cycle
From eligibility to adjudication. Covered.
Audit and appeals are the workhorses, but Ember protects allergy & immunology revenue at every stage of the cycle.
Eligibility Verification
Confirms active coverage and immunotherapy and drug benefit structure before the visit, and flags buy-and-bill biologic coverage gaps before they become billing problems.
Prior Authorization
Checks auth requirements in real time for asthma and urticaria biologics, step-therapy criteria, and IVIG infusions, generates medical-necessity documentation, and submits to payer portals automatically.
AI Medical Coding
Reviews 100% of encounters, antigen unit counts, injection administration codes, buy-and-bill drug units, and allergy testing, against national standards and payer rules before claims submit.
Pre-bill Audit
Predicts and prevents denials before claims go out, catching antigen unit and admin-code mismatches, drug-unit and wastage gaps, and medical-necessity issues before they generate write-offs.
Denial Management
Full appeal lifecycle for every allergy & immunology denial type, medical necessity, step-therapy failure, drug auth failure, and antigen unit error, tracked to adjudication.
Underpayment Recovery
Parses contracts to model what each immunotherapy, drug, and testing claim should pay, then surfaces line-item underpayments on high-cost biologic and immunotherapy claims at scale.
Immunotherapy and biologic revenue, recovered
-57%
denial rate
-45%
cost to collect
100%
encounters audited
3 days
to first results
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
Frequently asked questions
Everything you need to know about how Ember fits into your revenue cycle.
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
See what your allergy & immunology practice is leaving on the table
Bring us 30 days of denial data. We'll show you where the revenue is and exactly how Ember would recover it.