Denial Prediction and Optimization
Denial prediction, prevention, and prioritization to optimize your claim process
Denial Prediction, Prevention, and Prioritization
Denials are the biggest challenge to your revenue cycle, and the vast majority (86%) are avoidable in the first place. The current solutions and processes are failing, resulting in less revenue and barriers to patient care.
Identify problems earlier in the process to prevent denials from happening in the first place
To accurately predict denials before claim submission, IKS Health uses AI and machine learning to analyze historical claims, payer contract rules, and a proprietary algorithm to determine the likelihood of a denial.
Our autonomous solution learns and adapts based on historical claims and changing payer reimbursement rules and provides actionable insights to help to prevent denials. Administrative chores are lifted from clinicians, days sales outstanding are reduced, and cash flow is improved.
If a denial does occur, ensure that claims are fixed pre-submission
Our remediation and learning processes keep the same mistakes from happening in the future, increasing performance over time.
- We focus on the quickest and most promising opportunities to ensure that you are maximizing your revenue potential and help you better track outcomes and accelerate your cash flow
- Our full-cycle denials optimization tool goes from predicting and preventing denials before they happen to post denial recovery with continuous learning for future improvements
Denial Prediction, Prevention, and Prioritization Key Benefits
Improved Clean Claim Rates
Ensuring claims are correct and complete upon first submission is critical to achieving accurate and timely reimbursement. Our solution helps in identifying and correcting the root cause of denials in the first attempt.
Increased Net Revenue
Effective denial management helps healthcare enterprises optimize revenue by lowering denials, increasing collection rates, and maximizing reimbursement.
Less Manual Work
Proactively managing the denial process improves operational efficiency by lowering manual intervention, automating workflows, and minimizing rework on denied claims.
Audit Compliance
Our combination of AI technology with human support is able to learn and adapt based on historical data analysis and a proprietary algorithm, combining pragmatic technology and human expertise.
Staff Gets Back Hours Per Day
Our Denials Management solution saves hours of staff time from having to handle denial claims and identifying the most promising of any denials that do happen so that resources are applied appropriately.
Denials Management FAQs
Denial, Prediction and Prioritization uses powerful AI and predictive analytics that rely on historic patient behavior, benefits, and encounter data. Millions of patterns are analyzed to monitor trends, understand the cause, and proactively intervene with solutions before problems arise and the claim is submitted. Individual financial and behavioral models create insights for patient profiles, claim insights and compliance, patient payment propensity, and full patient engagement.
Because not all denials are preventable, we prioritize them with a focus on the quickest and most recoverable revenue for you. What is learned during this process is shared with the platform technology to optimize the workflow and prevent the mistake from happening again.
Traditional denial management uses an outdated, reactive technology that burdens administrative staff with fixing issues after they arise. Our offering is a tech with human oversight solution that provides denials insights, addresses the reasons for denials before they occur, and gets more claims paid the first time.