Revolutionizing Denial Management: How Healthrise’s Denials Navigator Transformed a $21 Billion Healthcare Organization’s Reimbursement Process

At Healthrise, we understand the critical role that efficient denial management plays in ensuring healthcare systems stay financially healthy. That’s why we’ve developed innovative solutions that empower healthcare providers to proactively tackle payer denials with precision and efficiency.

Our flagship tool, Denials Navigator, is designed to transform the way healthcare organizations handle denial challenges. This intelligent, decision-support platform not only monitors denial inflow in real time, but it also alerts operators to targeted populations of denials that need investigation. With Denials Navigator, healthcare systems gain clear, actionable insights and a streamlined approach to tracking outcomes, ensuring a smoother, faster reimbursement process.

Challenges 

A case in point: One of our national clients, with over $21 billion in annual revenue, was struggling with the significant roadblocks posed by payer denials. Despite delivering high-quality care, their team was bogged down by the time and resources needed to resolve these denials, often causing delays in reimbursement. This challenge required a fresh approach.

Solution

By implementing Denials Navigator, Healthrise enabled this client to proactively identify denial trends, prioritize efforts for maximum impact, and resolve claims more efficiently. The result? A quicker, more effective path to reimbursement, freeing up valuable time and resources for patient care.

Benefits

Our client experienced a transformative improvement in both operational and financial performance.

AI-Powered Insights

By harnessing the power of Navigator’s AI/ML, our client implemented advanced tools to identify and alert teams to root causes of denials. These tools tracked prevention initiatives and quantified the financial impact of actions taken, providing a clear ROI for efforts and ensuring continuous improvement.

Centralized Expertise

The team was reorganized, redeploying colleagues into a centralized structure that empowered dedicated experts to collaborate across regions. This unified approach allowed for a cohesive, data-driven strategy to address and resolve complex denials.

Accelerated Resolution Times

The use of AI-driven analytics enabled the team to detect abnormal variations and trends faster than traditional manual reviews. This drastically reduced the time needed to identify issues and implement resolutions, streamlining workflows and increasing operational efficiency.

Conclusion

Faced with fragmented efforts and resource-intensive manual processes for managing complex payer denials, $21+B client implemented a centralized, consultant-supported AI solution, Denials Navigator, to streamline workflows, identify root causes, and accelerate resolution times for improved financial outcomes.​

Ready to see how Healthrise can transform your denial management process?

Contact us today to learn more about how we helped our client streamline their denials management and increase their financial efficiency.

Discover our full technology product suite:

Denials Navigator

Centralize and standardize tracking for all denials prevention efforts and results across your health system  to proactively tackle denial challenges with unparalleled efficiency and precision.

Quality Audit + Productivity

Streamline the auditing process, provide comprehensive reporting capabilities, and facilitate staff assessments, all in one user-friendly platform. With QA+P, managers can easily identify areas for education and process improvements across all revenue cycle teams.

Revenue Cycle Analytics

Powered by advanced algorithms and intuitive dashboards, our platform provides comprehensive insights into revenue cycle performance, allowing hospitals to identify trends, pinpoint areas for improvement, and optimize workflows.

Schedule a demo with our team to help you find the right tools and integrations to meet your goals!