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Denial Management Software for Healthcare RCM Teams

Denials 360 gives RCM teams AI-powered triage, root cause analytics, underpayment recovery, and payer-ready appeals — all in one HIPAA-compliant platform.

See It In Action How It Works →
HIPAA Compliant
Built on Microsoft Azure
PHI Isolated Per Client
SOC 2 Type II
📈
Recovery Rate
+34% this quarter
Denial Propensity Queue
Live
847
Open Denials
$1.2M
At Risk
91.4%
Clean Claim
Claims Requiring Action
CLM-4521
Aetna
$18,450
Critical
2 days
Work →
CLM-4518
United Health
$24,800
Critical
1 day
Work →
CLM-4515
BCBS
$12,200
High
5 days
Work →
CLM-4509
Humana
$15,300
High
4 days
Work →
⚠️
Timely Filing Alert
14 claims expiring soon
77%
of providers say claim denials have increased since 2022
RevCycle, 2024
$118
average cost to rework a single denied claim
HFMA
75hrs
per week spent on denial-related work per RCM team
Adonis Survey, 2026
$16B
in revenue lost to RCM inefficiencies in 2025
ChartLogic, 2025
THE PROBLEM

Your team is spending more time researching denials than resolving them

Payers use AI to deny faster. Your team is still working from aging reports and multiple disconnected systems. Every hour spent on manual research is an hour not spent recovering revenue.

🔄
Constant payer rule changes
Adjudication rules change without notice. Prior auth requirements keep expanding. Your team can't keep up manually.
🧩
Fragmented workflows
Analysts switch between multiple systems — eligibility, authorization, claim history, payer policies — losing hours every day.
📉
Revenue leaking undetected
Timely filing gaps, missed appeals, and underpayments that look like paid claims — revenue that disappears quietly.
45 min
Average time per denial research
65%
Appeals that miss key documentation
6 mo
Time to get a new analyst productive
$262B
Lost to denials industry-wide
DENIAL ANALYTICS

Know exactly where your denials are coming from

Real-time dashboards surface denial trends by payer, CPT/HCPCS code, ICD-10 diagnosis, facility, and CO/PR reason code — giving your leadership live insight into root causes, not just volume.

✓
Denial rate by payer — spot adjudication behavior shifts before they compound
✓
Root cause breakdown — CO, PR, and OA codes categorized automatically
✓
AR aging by denial type — see where oldest revenue is stuck and why
✓
Live dashboards — no more waiting for a report that's two weeks old
Denial Root Cause Analysis — Last 30 Days
Live
Prior Auth — Invalid34%
Prior Auth — No Auth28%
Coding Mismatch (CPT/ICD-10)19%
Payer Error / Denied in Error12%
Eligibility / Coverage7%
2,341
Analyzed
$847K
Recovered
$312K
Pending
RCM AGENT — PRIOR AUTH

Denial assessment & AI recommendations that give your analysts 10x productivity

The Prior Auth RCM Agent assesses every prior authorization denial, identifies the root cause, and delivers a precise AI-recommended action plan — so your analysts spend their time executing, not investigating. What used to take 45 minutes now takes under 5.

✓
Instant denial assessment — root cause identified the moment a claim is denied
✓
AI-generated action plan tailored to the denial type, payer, and applicable SOP
✓
Guides analysts through CPT mismatches, field locator 63 errors, retro auth, and 3rd party failures
✓
New analysts productive from day one — no institutional knowledge required
10x
analyst productivity increase
45→5min
per prior auth denial worked
🤖 Available as add-on on any Denials 360 plan
Prior Auth Agent — Active
AI AGENT
✓
Denial analyzed — root cause identified
CPT mismatch detected. Auth approved for 27447-LT, claim billed 27447-RT (laterality discrepancy).
Invalid Authorization — CPT Mismatch
✓
Payer guidelines retrieved
Aetna allows auth update for CPT laterality corrections within 90 days of DOS. Within timeframe confirmed.
3
Route to coding team for CPT review
Verify if 27447-RT was the correct procedure. If correct, contact Aetna to update auth. If coding error, submit corrected claim.
4
Submit retro auth or corrected claim
Based on coding review outcome — submit retro auth within 90-day window or file corrected claim with updated CPT.
5
Document outcome and close
Update account notes, log resolution action, confirm reprocessing or payment posted.
DAILY WORKFLOW

Everything your analysts need, in one place

RCM teams lose hours every day context-switching between systems. Denials 360 is a single, purpose-built denial management workspace — from open to close, without leaving the platform.

💬
Claim notes & comments
Document every action on the claim — visible to the full team, timestamped for audit
⏰
Follow-up reminders
Track payer callbacks, retro auth deadlines, and reprocessing follow-ups
⚡
Timely filing alerts
Automatic flags when claims approach payer filing deadlines — before revenue is forfeited
📋
Appeal case management
Build, track, and submit appeals without leaving the denial management screen
Claim Workspace — DN-4821 ⚠ Invalid Auth
Aetna — Prior Auth Denial
CPT 27447 — Total Knee Replacement
DOS: 02/15/2026
Auth #: AET-889243
Denied: $24,850
Filing: Mar 30
Activity & Notes
JS
Called Aetna — auth approved for 27447-LT, claim billed 27447-RT. CPT mismatch confirmed.
Mar 14 · 2:34 PM
AI
Agent recommendation: Route to coding for CPT laterality review. Submit corrected claim if coding confirmed.
Mar 14 · 2:35 PM · Prior Auth Agent
SMART APPEALS

Complete appeals in minutes, not hours

Denials 360 generates payer-ready appeal letters using the denial reason code, claim details, authorization history, and clinical context already in the system — with payer-specific formatting applied automatically.

✕ Denied Claim CO-15 · United Health
Denial Reason
CO-15 — Prior Auth Not Obtained
CPT Code
99285 — ED E&M Level 5
Amount Denied
$4,200.00
Auth Status
Auth obtained, not billed on claim
AI
generates
~3 min
✓ Appeal Letter Ready
Re: Formal Appeal — Claim #UHC-2026-00441

Authorization #UHC-PRE-774821 was obtained prior to the date of service and covers CPT 99285. The authorization number was inadvertently omitted from field locator 63 on initial submission.

We respectfully request expedited reprocessing with the enclosed authorization confirmation.
⏱ From 45 min → under 5 min
✍️
Payer-specific appeal letters
AI generates using denial reason, auth history, and clinical context — pre-populated for the specific payer
📝
Payer forms pre-filled
Required forms auto-populated. No more hunting for the right form or manually entering claim data
📦
One consolidated package
Letter + forms + documentation bundled into a single file — ready for payer portal upload in one click
🤖 NEW
Appeals Agent
AI-drafted. Human-approved. Faster than ever.
Appeals Agent handles the research, drafting, documentation assembly, and batch queuing — so your analysts spend their time reviewing and approving, not building appeals from scratch. Every appeal goes out with a human sign-off.
📋 Appeal Queue
→
🏥 Payer Criteria
→
✍️ Generate Letter
→
✅ Human Review & Approve
→
🚀 Send
2 min
Avg appeal time
76%
Success rate
UNDERPAYMENT RECOVERY

Recover revenue you didn't know you were losing

Denials get all the attention. Underpayments don't. Denials 360 uses machine learning to detect underpaid claims by comparing actual payer reimbursements against historical payer payment patterns — surfacing recovery opportunities that contract-based variance checks miss entirely.

✓
ML-based detection — not rules-based contract matching
✓
Detects deviations in payer's actual vs expected payment behavior
✓
EOB reconciliation — matches 835 remittance data against contracted rates
✓
Prioritized underpayment queue for your AR follow-up team
Underpayment Recovery Opportunities — Last 90 Days
Aetna — CPT 27447$31,200
United Health — CPT 99214$18,420
Cigna — CPT 93306$9,840
Humana — CPT 70553$6,150
💰
$65,610 in underpayments identified across 4 payers and 847 claims in the last 90 days.
TEAM PERFORMANCE

The metrics your managers actually need

Real-time visibility into analyst productivity, denial resolution rates, appeal outcomes, and timely filing compliance — so you can manage the team, not just the claims.

📊
Claims worked per analyst / day
Individual and team throughput — see where bottlenecks are before they compound
🎯
Resolution rate by denial type & payer
Which categories your team resolves fastest and where claims are getting stuck
⚖️
Appeal win rate by reason code
Which appeals work and which denial reason codes need a different strategy
📅
AR aging by denial type
Where the oldest revenue is sitting — and why it hasn't moved in the queue
✅
Clean claim rate over time
Whether your prevention work is reducing initial denial volume month over month
⏰
Timely filing compliance by payer
Which payers are approaching filing deadlines before revenue is permanently forfeited
FAQ

Frequently asked questions

What is denial management software for RCM teams?
+
Denial management software helps healthcare revenue cycle teams track, triage, resolve, and appeal denied claims. Denials 360 adds AI-powered root cause classification, payer analytics, underpayment detection, and automated appeal generation — built specifically for RCM teams at health systems, hospitals, and RCM outsourcing companies.
How does the Prior Auth AI Agent resolve prior authorization denials?
+
The Prior Auth RCM Agent analyzes the denial, classifies the root cause (invalid auth, no auth, or payer error), and guides the analyst step by step through resolution — including whether to contact the payer, submit a retro auth, resubmit with field locator 63 populated, or resolve a third-party communication failure with Evicore, Carelon, or Turning Point.
What's the difference between a claim denial and an underpayment?
+
A claim denial is when the payer rejects the claim entirely. An underpayment is when the payer processes the claim but pays less than the contracted rate. Both result in revenue loss — but underpayments are much harder to catch at scale. Denials 360 addresses both using ML-based underpayment detection alongside standard denial management workflows.
Is Denials 360 HIPAA compliant?
+
Yes. Denials 360 is built on HIPAA-compliant Microsoft Azure infrastructure. PHI is encrypted at rest and in transit. Each client's data is stored in a fully isolated database — no shared environments. A Business Associate Agreement (BAA) is executed before any protected health information is transferred to the platform.
Can Denials 360 handle Evicore, Carelon, and Turning Point denials?
+
Yes. The Prior Auth RCM Agent includes a dedicated resolution workflow for third-party authorization failures — contacting Evicore, Carelon, or Turning Point to confirm authorization dates and Hospital NPI, requesting the approved authorization be submitted to the payer, and following up if the third party has not yet sent it.
How quickly can our team get started?
+
Most teams are working denials within days of onboarding. DataRovers provides full onboarding support — data integration, user training, and platform configuration — at no additional charge. No setup fees.
Ready to recover more revenue?

The denial management platform built for healthcare RCM teams

Denials 360 speaks your language — prior auth, retro authorization, field locator 63, CO and PR denial codes, timely filing. Your team productive on day one.

Request Demo Talk to Our Team →
HIPAA Compliant
Built on Azure
SOC 2 Type II
No Setup Fees