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Automated Denial Management

Turn Denials into Revenue with Intelligent Appeals

Leverage our Healthcare Knowledge Graph to automate evidence gathering, build payer-specific arguments, and increase your appeal success rate—recovering revenue that would otherwise be lost.

The High Cost of Manual Appeals

High Staff Overhead

Manual research into clinical documentation and payer policies consumes valuable staff time and increases the cost to collect.

Complex Payer Policies

Navigating hundreds of pages of complex, ever-changing payer policies leads to inconsistent and ineffective appeals.

Ineffective Templates

Generic, template-based appeals lack the specific clinical and policy evidence required to overturn denials.

Increased Revenue Leakage

Low appeal success rates and missed filing deadlines result in significant, preventable revenue leakage.

IS TRANSFORMED WITH INTELLIGENT AUTOMATION

The Intelligent Automation Solution

Automated Evidence Synthesis

Our AI instantly synthesizes clinical evidence from your documentation with the payer's denial reason.

Targeted Policy Analysis

The Healthcare Knowledge Graph pinpoints the exact payer policy rules relevant to the denial, eliminating manual research.

Evidence-Based Appeals

Each appeal letter is automatically generated, citing specific clinical evidence and quoting the payer's own policies.

Improved Recovery Rates

Dramatically increase your appeal success rate, reduce denial write-offs, and accelerate revenue recovery.


Our Intelligent Appeal Workflow

Step 1: Evidence Aggregation

Clinical Documentation Analysis

The platform ingests and analyzes all relevant case files, including operative notes and reports.

Denial Reason Code Analysis

We parse the payer's denial communication to identify the core reason for the rejection.

Payer Policy Retrieval

Our Healthcare Knowledge Graph retrieves the specific, up-to-date payer policy for the denial.

Step 2: AI-Powered Case Synthesis

1. Establishes Clinical Context: Understands the specific medical scenario from your documentation.

2. Applies Payer-Specific Rules: Selects the correct policy document based on the payer and denial code.

3. Extracts Justifying Evidence:

The AI analyzes the full policy and extracts the precise sections that justify the service, forming the core of the appeal.

Step 3: Automated Appeal Generation

Generated Appeal Letter

  • Links Clinical Evidence: Connects information from your documentation directly to medical necessity criteria.
  • Constructs a Compelling Argument: Quotes the payer's own policies and guidelines to prove compliance.
  • Generates an Audit-Ready Record: Produces a complete evidence package for each appeal, ensuring transparency.

The Outcome: Recover More Revenue, Faster

Reduce Staff Burden

Eliminate hours of manual research per appeal, lowering your cost to collect and freeing up staff for high-value tasks.

Increase Appeal Accuracy

Ensure every appeal is built on the correct, most current payer policies, dramatically improving consistency and quality.

Maximize Recovery Rates

Move beyond ineffective templates with custom, evidence-based arguments that significantly increase your appeal success rate.

Accelerate Cash Flow

Shorten the denial-to-payment cycle by submitting winning appeals faster, reducing A/R days and preventing revenue leakage.

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