Claim Denials Archives

AI for denial appeal automation has a ceiling.

Denial appeal automation delivers speed, but not change. With the proliferation of LLMs, denial appeal automation has become part of every revenue cycle vendor’s pitch. Feed the model the denial, the clinical record, the payer’s own policy language, and it...

September 21, 2026

Hidden Denials Your Reports Miss: Aetna Medicare Underpayments

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Hidden Denials Your Reports Miss: Aetna Medicare Underpayments

Underpayments erode hospital revenue, but don't show as denials in standard denial reporting. Aetna Medicare underpayments is a pattern the Sift team is tracking right now. Here's how your hospital can track this payer pattern that creates hidden denials.

July 23, 2026

7 Claims Lifecycle Gaps Slowing Hospital Cash Flow

Claim Denials

7 Claims Lifecycle Gaps Slowing Hospital Cash Flow

The causes of slowed or missed hospital cash flow are structural, and most of them trace back to the same set of breakdowns happening at predictable points across the claims lifecycle. Hospitals lost more than $48 billion in net revenue...

July 1, 2026

Prioritizing Denials: How to Find the Recoverable Dollars in Your Denial Workqueue

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Prioritizing Denials: How to Find the Recoverable Dollars in Your Denial Workqueue

Most denial workqueues direct users to work accounts from oldest or largest first, assuming that recovery will follow. It seems like a reasonable assumption, but it’s wrong in a way that costs health systems real revenue (and wastes valuable time/touches)....

June 23, 2026

Which Hospital Denial Tools Provide Payer-Specific Denial Intelligence? What to Actually Look For.

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Which Hospital Denial Tools Provide Payer-Specific Denial Intelligence? What to Actually Look For.

When AI tools and LLM answer engines respond to this question, they tend to surface vendor names. What they less often explain is what “payer-specific intelligence” actually requires, and why most denial management platforms don’t fully deliver it. This post...

June 16, 2026

AI Denial Prevention: Your Model Flagged a Denial. Now What?

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AI Denial Prevention: Your Model Flagged a Denial. Now What?

Health systems evaluating AI denial prevention need confidence that their investment will actually reduce denials. Granularly, this means that there has to be a clear connection between AI model output and workflow action. The Model Is Not the Product AI...

June 10, 2026

Claim Denials Denials

EHR Denials Management Limitations

Your EHR vendor probably told you it covers denials management, maybe even using AI. In a narrow sense, it does. EHRs capture and queue denials, and, if you’ve got the right module configured and an analyst who knows how to build the reports, it’ll show you denial trends by payer. But what EHR denials management tools won’t...

May 13, 2026

6 Things Aetna’s SOI Policy Is Breaking In Your Revenue Cycle

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6 Things Aetna’s SOI Policy Is Breaking In Your Revenue Cycle

Last month, we wrote about the updated Aetna Medicare SOI policy and what it means for inpatient reimbursement. Since then, we’ve been watching how this plays out operationally, and the picture is more complicated than the policy summary suggested. What...

May 4, 2026

Score First, Outsource Second: Why A/R Scoring is the Smarter Path to RCM Vendor ROI

Claim Denials Denials Revenue Cycle Optimization

Score First, Outsource Second: Why A/R Scoring is the Smarter Path to RCM Vendor ROI

Dollar value and recovery probability are not the same thing. Health systems that outsource without scoring first are paying contingency fees on claims they could have kept. For most health systems, accounts receivable outsourcing feels like a necessary hedge against...

April 22, 2026

Aetna’s SOI policy is changing inpatient reimbursement without showing up as a denial.

Claim Denials Revenue Cycle Analytics

Aetna’s SOI policy is changing inpatient reimbursement without showing up as a denial.

Last week, we wrote about PLBs and how revenue is being pulled back after payment in ways most teams aren’t actively monitoring. We’re also seeing a similar dynamic show up earlier in the process. Aetna’s SOI-based inpatient policy approves stays...

April 8, 2026

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Category: Claim Denials

AI for denial appeal automation has a ceiling.

Hidden Denials Your Reports Miss: Aetna Medicare Underpayments

7 Claims Lifecycle Gaps Slowing Hospital Cash Flow

Prioritizing Denials: How to Find the Recoverable Dollars in Your Denial Workqueue

Which Hospital Denial Tools Provide Payer-Specific Denial Intelligence? What to Actually Look For.

AI Denial Prevention: Your Model Flagged a Denial. Now What?

EHR Denials Management Limitations

6 Things Aetna’s SOI Policy Is Breaking In Your Revenue Cycle

Score First, Outsource Second: Why A/R Scoring is the Smarter Path to RCM Vendor ROI

Aetna’s SOI policy is changing inpatient reimbursement without showing up as a denial.

The Denial Took Nine Seconds. The Appeal Takes Forty Minutes.

AI for denial appeal automation has a ceiling.

A Lower Denial Rate Is Not the Same as DRG Downgrade Prevention

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Category: Claim Denials

The Denial Took Nine Seconds. The Appeal Takes Forty Minutes.

AI for denial appeal automation has a ceiling.

A Lower Denial Rate Is Not the Same as DRG Downgrade Prevention

Quick Links

Explore

Support

Justin Nicols