Denials Archives

Top 8 Denials Management Metrics Every Hospital Should Track

The Denials Management Metrics That Actually Matter in 2026 For years, the denials scorecard was settled and denials management metrics were simple. Initial denial rate, denials by CARC code, overturn rate and days in AR. If those numbers looked good,...

July 6, 2026

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

Claim Denials Denials

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.

Claim Denials Denials

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?

Claim Denials Denials

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

CEO Perspectives: Proactive Denial Management, What the SaaS Repricing Tells Us

Denials Innovation

CEO Perspectives: Proactive Denial Management, What the SaaS Repricing Tells Us

The Market that Rewards Managing Problems The dominant revenue cycle business models have a structural incentive not to solve the most fundamental problems in the revenue cycle (denials). That’s not a criticism of execution. The people building these businesses are...

June 4, 2026

5 Levels of Denial Reporting — And Why Most Health Systems Stop at 3

Denials

5 Levels of Denial Reporting — And Why Most Health Systems Stop at 3

Your EHR denial reporting probably answers these questions well: How many accounts did each rep touch? Which queues are aging? What’s your denial rate by payer? Those are legitimate operational questions. But they’re activity questions, and activity isn’t outcome. The...

May 21, 2026

Denials

Payments Intelligence Impact Point: $13M Recovered From $43M in Aged Denials.

A large regional health system had a problem familiar to most revenue cycle leaders, a sizable book of denied, aged accounts that their internal prioritization logic had effectively written off. These accounts were buried under a rules-based workqueue that couldn’t...

May 19, 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

Claim Denials Denials

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

How to Know if a Denial Cluster is Worth Automating with an AI Agent

Denials Revenue Cycle Analytics

How to Know if a Denial Cluster is Worth Automating with an AI Agent

Agentic AI is being hailed across the revenue cycle right now, for appeals, claim resubmissions, documentation retrieval and a slew of other workflows. For the most part, the use cases make sense on paper. But many health system revenue cycle teams are making deployment decisions based on...

April 30, 2026

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Category: Denials

Top 8 Denials Management Metrics Every Hospital Should Track

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?

CEO Perspectives: Proactive Denial Management, What the SaaS Repricing Tells Us

5 Levels of Denial Reporting — And Why Most Health Systems Stop at 3

Payments Intelligence Impact Point: $13M Recovered From $43M in Aged Denials.

EHR Denials Management Limitations

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

How to Know if a Denial Cluster is Worth Automating with an AI Agent

Top 8 Denials Management Metrics Every Hospital Should Track

7 Claims Lifecycle Gaps Slowing Hospital Cash Flow

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

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Category: Denials

Top 8 Denials Management Metrics Every Hospital Should Track

7 Claims Lifecycle Gaps Slowing Hospital Cash Flow

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

Quick Links

Explore

Support

Justin Nicols