Denial Manager

Healthtek, a Data-Core Systems Company, delivers essential services and tools to support
providers and payers in their Healthcare Revenue Cycle Management (RCM).

The offerings include:

Revenue Cycle Optimization services that enhance financial success.
A suite of Healthcare Automation Tools that improve RCM KPIs in real-time.

Reduce Claim Denials with Healthtek's AI-Powered Denial Manager

Built on our patented AI Platform Ruzivo™, Healthtek’s Denial Manager works in tandem with a traditional Rules-based approach to predict the probability of denial of a claim, and the most-likely reasons for the same, before claim submission. Developed and trained with the insights from analyzing over 30 million In-Patient and Emergency Department claims, the AI/ML models at the core of our Denial Manager can identify various reasons for claim denials and help providers take action to reduce them. Denial trend analysis is also performed by studying a variety of denial reasons, focusing on the ones most frequently encountered by providers.

Industry Challenge

Did you know that the average medical claim denial rate is 9%? Out of the $3 trillion worth of medical claims submitted, about $262 billion are initially denied. From coding and billing errors to missing documentation or patient eligibility issues, claim denials are an expensive problem that slow down revenue cycles. On average, processing a denied claim can take between 45-60 days.

That’s where Healthtek’s Denial Manager comes in. Our solution is designed to reduce denial rates to less than 5% and cut down accounts receivable times to under 45 days, helping you recover revenue faster and more efficiently.

How Denial Manager Works

AI/ML Engine:

Trained on historical claim denial data, the machine learning models in our AI/ML Engine recognize denial patterns.

Based on the training from historical claim data, the system predicts the probability of denial of a new claim.

The AI/ML Engine is designed to handle more complex denials by analyzing patterns. This allows it to address & identify issues and learn from experience.

Continuous learning from ‘go-forward’ denials improves performance by enabling the system to adapt and refine its algorithms based on new data and patterns.

Rules Engine

Our Rules Engine detects common, straightforward denial triggers using predefined criteria, without the need for AI/ML, ensuring quick identification of easily preventable denials.

Interpretation Module

The Interpretation Module provides actionable insights by analyzing the AI/ML Engine’s output, allowing you to determine and resolve the claim elements most likely to cause the predicted denial. With these insights, it is much easier to understand the underlying issues and correct claims prior to submission.

Why Choose Healthtek’s Denial Manager?

Cut Denial Rates to Below 5%

Significantly reduce the likelihood of claim denials.

Bring down Accounts Receivable

Reduces average accounts receivable to <45 days to accelerate your revenue cycle.

Predict Over 97% of Initial Denials

Proactively address denials before submission with unmatched accuracy.

Less than 0.5% False Positives

Ensures that fewer than 0.5% of clean claims are flagged as potential denials.

24-Hour Turnaround

Quick turnaround gives you fast, reliable insights.

Proven Results

Healthtek’s Denial Manager solution can correctly predict upwards of 99% of denials when tested on 150,000 claims using the AI/ML and Rules Engines