Denials 360 combines intelligent triage, AI-powered analysis, and automated appeals into one streamlined workflow. Your analysts work smarter. Your revenue recovers faster.
AI validates claims against payer policies, checks DRG accuracy, and verifies medical necessity—all in seconds.
Every denial requires research across multiple systems. Policy lookups. Documentation reviews. Appeal letter writing. It's slow, inconsistent, and burns out your best people.
Average time per denial research
Appeals that miss key documentation
Time to train new analyst
Lost to denials industry-wide
Stop guessing which claims need attention. Smart Queues automatically prioritize your workload based on the factors that matter most to your revenue.
Claims most likely to be denied, flagged before submission
Group by Claim Adjustment Reason Codes for pattern analysis
Remittance Advice Remark Codes to understand payer requirements
Organize by payer for targeted workflow optimization
Prioritize high-dollar claims for maximum revenue impact
Track timely filing deadlines and escalate aging claims
AI tools that handle the research, validation, and planning—so your team can focus on decisions that need human judgment.
Analysts spend hours cross-referencing payer policies
DRG downgrades and missed upgrades cost millions
Medical necessity denials are time-consuming to research
New analysts struggle with complex denials, experienced ones waste time on routine cases
Every denial gets a step-by-step action plan generated by AI. The system uses your SOPs first—ensuring consistency with your standards. If no SOP exists, it falls back to industry best practices.
Based on your SOP: Denial-CO50-v2.3
Verify medical necessity criteria against payer LCD
Pull clinical notes for dates of service
Check prior authorization status
Prepare appeal letter with supporting documentation
Submit via payer portal within 48 hours
Everything you need for a winning appeal—generated, assembled, and packaged in one click. One consolidated file ready for payer portal upload.
AI generates payer-specific appeal letters with the right language, citations, and arguments for each denial type.
Pre-populated denial forms with all required fields completed. No more hunting for the right form or manual data entry.
Automatically attaches relevant clinical documentation, progress notes, and supporting evidence to strengthen your case.
Everything bundled into a single consolidated file ready for upload. Letter + forms + records = one click submission.
Appeals Agent takes it further. It generates the appeal, assembles the package, and submits directly to payer portals—all without human intervention. Your team only steps in for exceptions.
Average appeal time
Success rate
Analyzed denial reason: CO-50
0.3sGenerated appeal letter
1.2sAttached clinical documentation (12 pages)
0.8sPre-filled Aetna appeal form
0.5sCreated submission package
0.2sUploading to payer portal...
What happens when your team gets the right tools.
More claims worked per analyst
Claims approved on first submission
When using Smart Appeals
With AI Action Plans
Native integrations with major EHRs and practice management systems. Setup in days, not months.
See how Denials 360 can streamline your workflow and boost your recovery rates. Schedule a personalized demo with our team.