Unlimited Systems AI Denial Management

Overview

Key Features

• Denial Prediction: Scores every claim against payer policy, coding edits, and historical remit outcomes before submission, holding likely denials for correction.
• Root-Cause Analysis: Groups denials by payer, code, provider, and reason to address upstream causes.
• Prioritized Work Queues: Ranks open denials by value and filing deadline for efficient staff workflow.
• Appeal Preparation: Supports the preparation of appeals for denied claims.
• Learning from Remits: AI learns denial patterns from historical remittances to prevent future denials.
• Pre-Submission Denial Prevention: Flags risks before claims are submitted.
• Automated Payment Posting: Remittances post automatically against payer-specific rules.
• Denial Trending: Tracks claim denials over time, grouped by payer, reason code, provider, procedure, and location to identify and fix recurring issues.
• Workflow Integration: Denials are routed into existing staff work queues.
• Human Oversight: Uncertain cases are routed to a person for review.

Use Cases

• Predicting and preventing claim denials before submission.
• Streamlining the denial management and appeals process.
• Identifying root causes of denials to improve upstream workflows.
• Automating routine revenue cycle tasks like eligibility checks, charge scrubbing, and remittance posting.
• Optimizing cash flow and increasing staff productivity in specialty healthcare practices.
• Analyzing denial trends to uncover insights and support business decisions.