15% of claims are rejected on first pass, creating an endless cycle of denials, appeals, and rework. Our AI analyzes every claim pre-submission, matches against real-time payer rules, and automatically generates appeal packages when needed.
Flag 80% of denials before submission
Achieve 96% first-pass acceptance rate
Recover $12M+ in prevented denials annually
Every denied claim costs $118 to rework and delays revenue by weeks
4 specialized AI agents create an impenetrable denial prevention system
Prior Authorization
94% preventable with AI
Eligibility
91% preventable with AI
Missing Information
88% preventable with AI
Coding Errors
92% preventable with AI
Watch how our AI agents work together to transform your denial management
Prevention Timeline
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Predictor Agent
ML models score denial risk on every claim
Risk Analysis
Claim patterns analyzed across payers
High Risk Alert
87% denial probability detected
Model Updated
Prediction accuracy improved to 94%
Rule Checker
Real-time validation against payer policies
Policy Sync
Latest payer rules downloaded
Auth Required
Missing prior auth identified
Code Mismatch
Invalid CPT/ICD combination flagged
Appeal Generator
Drafts evidence-based appeals automatically
Documentation Gathered
Clinical notes compiled
Appeal Drafted
Evidence-based appeal generated
Success Tracked
92% appeal win rate achieved
Learner Agent
Continuously improves from outcomes
Pattern Detected
New denial trend identified
Rules Updated
Prevention logic enhanced
Knowledge Shared
Insights distributed to all agents
AI prevents denials before they happen
Claims go through clean on first submission
Automated appeal generation saves days
AI improves with every claim processed
Pre-submission denial prediction with 94% accuracy
Real-time payer rule validation across 3,000+ payers
Automated prior authorization management
Missing documentation alerts before submission
Evidence-based appeal package generation
Continuous learning from denial patterns
Integration with all major clearinghouses
Compliance with latest regulatory requirements
Join leading hospitals using AI to transform denials from a revenue drain into a competitive advantage through intelligent prevention.