Healthcare providers lose billions every year to unworked denials. Denials 360 gives your RCM team the analytics, workflow, and AI tools to recover that revenue — without adding headcount.
Payers are using AI to review and deny claims faster than any manual team can respond to. Medicare Advantage denial rates hit 15.7% in 2024. Payer audits are up 30% year-over-year. Meanwhile, 63% of providers report staffing gaps in their billing departments — turnover in RCM roles runs above 25% annually.
Built around the way your RCM team actually works — from understanding the problem, to knowing what to tackle, to getting it resolved. No spreadsheets. No switching systems.
Most health systems don't have a clear picture of their denial patterns. Reports are delayed. Data is siloed. By the time leadership sees a problem, it's already months old.
Denials 360 gives you a live view of every denied claim the moment it enters the system — broken down by payer, CARC/RARC code, service line, CPT group, and provider.
When your team has more denied claims than hours in the day, how they spend their time determines how much revenue you recover. Denials 360 removes the guesswork entirely.
Every denied claim is automatically scored and placed in a prioritized work queue based on dollar value, payer, denial type, and appeal likelihood.
The appeal stage is where revenue is won or lost. The Smart Appeals Agent inside Denials 360 drafts payer-specific, clinically grounded appeal letters in seconds — referencing the current payer policy, pulling in supporting documentation, and building the case your team would build, without starting from a blank page every time.
We help RCM teams recover revenue from claims that never received a payer response. By processing 277 status files, we surface stuck claims before they age into write offs.
We process 277 files to identify the claim status, flagging claims that are rejected or pending payer review.
We configure tracking windows for every carrier and plan type. Claims exceeding turnaround time surface automatically.
Sort queues by claim value, aging, or payer. Your team works the highest impact claims first, not random aging reports.
Managers see total outstanding revenue across every queue in real time. No more end of month surprises about AR at risk.
Every status update, payer response, and action is logged. Compliance is covered and team performance is measurable.
Act on 277 data instead of waiting weeks for 835s. Reduce days in AR and recover revenue before claims age out.
Medicare Advantage is not just another payer segment. It is the fastest-growing source of claim denials in the US — and the one most health systems are least equipped to manage. A generic denial management process is not enough.
The healthcare industry is projected to face a shortage of 3.2 million healthcare workers by 2026, including billing and coding professionals. RCM turnover runs above 25% annually. Every time an experienced biller leaves, they take institutional knowledge with them.
Denied claims inflate days in A/R, create uncertainty for finance teams, and compress operating margins. Hospital operating costs rose 8% in 2024 while revenue growth sat at 4%. Every dollar sitting unresolved in a denial queue is revenue you've already delivered care for — and haven't collected.
We onboard your team, connect to your existing systems, and have Denials 360 working in your environment — fast. No long-term contract required to get started.
We connect to your EHR, map your denial data, and have your team working claims with AI support — fast. No long-term contract required to get started.