Fertility benefits are a maze. Verify them before treatment begins.
Fertility coverage is the most variable in medicine. Many plans exclude IVF, others cap lifetime dollars or cycles, and state mandates and employer benefit managers add layers on top. One missed benefit detail and a five-figure cycle isn't covered. Ember verifies the exact benefit before treatment and works every denial.
Trusted by specialty groups and health systems
Where fertility revenue leaks
The denial patterns Ember was built for
Fertility coverage is the most variable in medicine. Many plans exclude IVF outright, others cap lifetime dollars or cycles, and state mandates and employer benefit managers add layers on top. One missed benefit detail and a five-figure cycle isn't covered. Ember verifies the exact benefit before treatment begins and works every denial.
01 · Coverage that varies by plan & employer
Treatment that's covered on one plan and excluded on the next.
IVF is excluded on many plans, carved out to third-party fertility benefit managers on others, and shaped by state mandates everywhere. Without verifying the exact benefit up front, practices treat patients who were never covered. Ember confirms the plan, mandate, and benefit-manager terms before the first monitoring visit.
S4015 · 58970 · Benefit max02 · Benefit exhaustion mid-cycle
Lifetime caps and cycle limits that run out partway through.
Monitoring, retrieval, transfer, and cryopreservation each draw down a lifetime dollar maximum or cycle allowance, and manual teams can't track the running balance across a cycle. Claims deny once the cap is hit. Ember tracks remaining benefit in real time and flags exhaustion before the next service is rendered.
58970 · 58974 · 89258 · Cap03 · Diagnostic vs treatment split
Diagnostics covered, treatment excluded, coded as one.
Most plans cover the fertility workup while excluding treatment, so monitoring ultrasounds, labs, and procedures must map to the covered benefit category or deny. Misaligned coding turns covered diagnostics into denied treatment. Ember validates each service against the plan's diagnostic and treatment boundaries before submission.
76830 · 89250 · Dx vs TxThree engines.
One source of truth.
Ember connects clinical documentation, verified benefit and authorization status, and contract terms into a single intelligence layer. Built for the benefit verification fertility billing has to get right before treatment starts.
01 · Foundation
Data Engine
Bridges the clinical and the financial. Unifies the cycle documentation, coding decisions, and contracts with verified benefit, lifetime-cap, and cycle status for every patient.
M. Idris
Case #FE-61204 · IVF cycle
02 · Audit
Coding Engine
Reviews 100% of services against coding standards, each plan's benefit and coverage rules, your internal guidelines, and your contracts. Every flag carries a rule citation.
Confirm remaining benefit before transfer — cap near
Plan benefit policy · confidence 0.98
03 · Recovery
Appeal Engine
Reads CARC and RARC codes, assembles the verified benefit and authorization terms in play, drafts the appeal letter, packages documentation, and tracks every claim to adjudication.
Re: Claim #FE-61204 · Denial CO-204
Services fall within the member's verified IVF benefit, authorization #AUTH-3390, with $3,200 remaining of the lifetime maximum…
Audit upstream.
Appeal downstream.
Two workflows do most of the work for fertility practices. The first prevents denials before they happen. The second recovers the ones that slip through.
Pre-bill audit
Verify the benefit before the cycle begins.
Ember reviews every cycle against the verified benefit, coding standards, and your contracts. Lifetime caps, cycle limits, authorization, and the diagnostic-vs-treatment split are validated before submission.
- 1
Verify before treatment
Confirms the exact fertility benefit, lifetime maximum, cycle allowance, and any employer benefit-manager terms before the cycle begins, not after the claim denies.
- 2
Validate against the benefit
Checks each service, monitoring, retrieval, transfer, embryo culture, and cryopreservation, against the covered benefit category, remaining balance, and authorization.
- 3
Recommend with citation
Returns the suggested coding or coverage action tied to the exact plan benefit, state mandate, or contract term.
- 4
Educate the team
Benefit-verification gaps and coding patterns drive team-level coaching, so financial clearance and coding accuracy improve across every provider and location.
Confirm remaining benefit before embryo transfer
Plan benefit + auth policy · confidence 0.98
+23%
Clean-claim rate
100%
Cycles reviewed
+5%
Net collection rate
Automated appeals
Pull. Review. Push.
When a denial occurs, Ember identifies the root cause, retrieves the cycle documentation and verified-benefit record, references the plan and contract terms, drafts the appeal, and tracks it through adjudication.
Not a benefit
Lifetime max
Auth required
Non-covered
Benefit appeal
-57%
Denial rate
-45%
Cost to collect
+9.3%
Net revenue per cycle
The full revenue cycle
From eligibility to adjudication. Covered.
Verifying the benefit is where fertility revenue is won or lost, but Ember protects it at every stage of the cycle.
Eligibility & Benefit Verification
Confirms the exact fertility benefit before treatment, lifetime maximum, cycle allowance, state mandate, and employer benefit-manager terms, so uncovered cycles never get started on the wrong assumption.
Prior Authorization
Initiates and tracks authorizations across plans and benefit managers, flagging the service a re-auth is due, so coverage never lapses mid-cycle.
AI Medical Coding
Reviews 100% of services, monitoring, retrieval, transfer, embryo culture and cryopreservation, and IVF global S-codes, against current plan rules before claims submit.
Pre-bill Audit
Predicts and prevents denials before claims go out, catching benefit exhaustion, non-covered treatment, and diagnostic-vs-treatment mismatches before they generate write-offs.
Denial Management
Full appeal lifecycle for every fertility denial type, non-covered benefit, lifetime max, authorization, and medical necessity, tracked to adjudication.
Underpayment Recovery
Parses contracts and fee schedules to model what each cycle should pay, then surfaces global-cycle and procedure underpayments at scale.
Fertility revenue, protected cycle to cycle
-57%
denial rate
-45%
cost to collect
100%
cycles 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 fertility 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.