Denials Archives

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

AI in the Revenue Cycle: A Priority, But…

AI in the Reveue Cycle Revenue Cycle Optimization

AI in the Revenue Cycle: A Priority, But…

AI in the revenue cycle isn’t at a tipping point; it’s a sticking point. Revenue cycle leaders at health systems across the country are being given AI mandates. At Sift, we’ve heard from multiple revenue cycle leaders that their CEOs...

May 26, 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

CEO Perspectives: Why the Revenue Cycle Industry Isn’t Designed to Fix the Revenue Cycle

Sift CEO Perspectives

CEO Perspectives: Why the Revenue Cycle Industry Isn’t Designed to Fix the Revenue Cycle

Denials are unequivocally one of the biggest problems for US health systems. But across the revenue cycle industry, most technology companies and outsourcing firms are not economically incentivized to solve the denial problem. They’re incentivized to make it manageable. The...

May 15, 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

CEO Perspectives: Health Systems Are Wrong About Their Denial Rates

Denials Sift CEO Perspectives

CEO Perspectives: Health Systems Are Wrong About Their Denial Rates

I don’t mean that to be provocative, I mean it literally. The number any given hospital revenue cycle team reports as its denial rate is almost certainly not its denial rate. Upstream Revenue Loss Most health systems measure denials through...

April 24, 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

Segment Loop 2110: Another Way Your 835 Isn’t Showing Your Denials

Denials Revenue Cycle Analytics

Segment Loop 2110: Another Way Your 835 Isn’t Showing Your Denials

The Loop 2110 segment was designed to communicate payer decisions. But payers have moved on, and health systems still managing denials through the remittance file are working with an incomplete picture. We’ve seen an influx of Google searches for “835...

April 15, 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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Tag: Denials

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

AI in the Revenue Cycle: A Priority, But…

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

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

CEO Perspectives: Why the Revenue Cycle Industry Isn’t Designed to Fix the Revenue Cycle

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

CEO Perspectives: Health Systems Are Wrong About Their Denial Rates

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

Segment Loop 2110: Another Way Your 835 Isn’t Showing Your Denials

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

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

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

AI in the Revenue Cycle: A Priority, But…

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Tag: Denials

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

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

AI in the Revenue Cycle: A Priority, But…

Quick Links

Explore

Support

Justin Nicols