Top 10 Denial and Appeal Management Alternatives & Competitors

Patients placed in the wrong bed status with improper documentation results in massive revenue loss and patient dissatisfaction.

Physicians can’t keep up with constantly changing criteria needed to admit patients to the hospital, and hospitals spend tons of money and resources fixing bed status issues retrospectively.

AdmissionCare provides the admitting physician with automated admission criteria - such as MCG - integrated directly into the EHR workflow to help document medical necessity that increases payer reimbursements and reduce denials.

How does it work?

• Integrate into the clinician's EHR workflow
• Determine the most appropriate bed status for each patient at admission
• Synchronize payer criteria with the clinician's documentation
• Collect revenue for the care provided, while avoiding costly denials

Payers constantly change the rules. Sift evens the playing field. Sift equips healthcare organizations to fully leverage their payments data to work smarter, protect their margins and accelerate cash.

Actionable Denials Intelligence, delivering a longitudinal view of clinical, coding, claims and remittance data. Sift establishes a data foundation that gives providers unprecedented access to their payments data and intelligence tools to better manage their denials, identify root causes and prevent future denials. 

• Unified, normalized and organized claims and remittance data.
• Delivering an accessible and complete picture of claim behavior, payer trends and the drivers of denials.
• Curated, consultative analysis pinpointing where your team can take action to prevent denials and optimize workflows.

Denials Prioritization & Intelligent Automation to better manage touches and lower the cost of delivering each dollar of cash.

• Sift’s machine learning optimizes workflows by prioritizing your team’s denial work efforts around ROI and by delivering Smart Claim Edits that improve first-pass yield. 
• Active-Learning Claim Scrubber analyzes daily claims and remittances to curate high-impact claim edit recommendations.
• Machine learning models that score denials at an atomic claim level, using over 500 attributes to determine each denial’s likelihood to overturn.
• ROI-based denials worklists seamlessly integrate into your EMR, prioritizing high-recovery denials in staff workqueues.
• Scoring that enhances existing automation capabilities, enabling the strategic automation of low-yield accounts while avoiding over-automating recoverable accounts.

Denials Prevention. By unifying clinical, coding and payments data, Sift's ML predicts denials before claims are created and provide recommendations for upstream interventions. 

Sift’s ML models predict the likelihood of denial and provide pointers for intervention and prioritized user analysis, working to optimize payment outcomes.

• Machine learning models score encounters around their likelihood of being denied, proactively flagging encounters for intervention before claim submission.
• Denial category prediction and root causes pointers enable routing to the appropriate mid-cycle workflow for mitigation.
• Mid-Cycle Denials Intelligence that ties back-end billing, denial and overturn patterns to upstream workflow data inputs to deliver root cause analysis and prevention recommendations.

Acuity Revenue Cycle Analytics is an analytics platform that leverages data from across the revenue cycle continuum (from patient access to remittance) to provide a holistic, cross-functional view into behaviors, processes and trends for the purpose of making timely decisions impacting financial outcomes, staff productivity and patient experience. • Dashboard showing a snapshot of critical information to quickly and easily identify problem areas in the revenue cycle. • Data compilation is automatic and in near real-time. • 80+ standard (yet also customizable) reports are available. • Users can create unique reports using any available criteria for unique use cases. • Suggested performance thresholds based on industry-wide data give context for whether performance is exceeding, on track or lagging goals. • Offers suggested thresholds or customize to meet unique needs. Visual indicators highlight when performance is outside of thresholds. • Acuity Advisor helps guide use of the wealth of data within the application by suggesting reports for common issues. • Reporting Bundles include visibility into data to improve processes in Patient Access, Services Rendered, Billing Efficiencies, Reimbursements, Denial Analysis, and Payer Relations.

Denials Workflow Manager product features: - Standalone or integrated: Can be used as standalone product, or integrated with Experian ClaimSource to align claims and denials information on the same screens. - Customizable: Work lists generated based on client specifications, such as denial category and dollar amount. - Analytics: Access standard product reports, analytics reports, and forward responses to HIS/PMS systems. - ANSI reason codes: Provides ANSI reason codes and payer proprietary codes as well as descriptions.

Our technology is organically built by RCM operators, for RCM operators. It is flexible and scalable with a fully integrated technology platform spanning the entire revenue cycle (front, middle and back) with >160 proven methods to drive standardization across the revenue cycle. We create continuous feedback loops to support comprehensive outcomes. We believe more value can be lost or created at the intersections between processes than inside a given process itself, and our technology unlocks this value.

MedData is more than just a vendor that improves A/R metrics. We are a trusted partner providing end-to-end revenue cycle management solutions for hospitals and physicians across all payer types. Because of our range of capabilities, we are able to handle any account regardless of origin – high/low dollar, re-billing, secondary/coordination of benefits, government payers, out-of-state Medicaid, accident accounts, Workers’ Comp, denials, etc. – and under any circumstances – small balance insurance follow-up, project-specific/work down of aged A/R, legacy receivable conversions, or as an extended business office. We triage accounts to identify problems and then share that knowledge with the hospital, which helps improve internal processes by fixing issues that contribute to avoidable denials. Our trending reports are based on specific KPIs established together with the hospital and delivered at the hospital’s preferred frequency. We track payer, denial type, service, and other trends to help drive improvements in a hospital’s processes that will lead to long-lasting gains in A/R performance. MedData has the capability to send out electronic 270/271 eligibility inquiry and to receive the response. We leverage the 270/271 response feature for many different scenarios such as: • Pure self-pay: to discover another payer source • Resolve issues with payer information that is on record in your system • Verify payer filing order We can process electronic claim submissions performing edits in any system and scrubbing where appropriate as well as working from any claim editing software. Our platform manages all elements of the project, giving the hospital full transparency into account activity and status. And it is administratively simple: We can work directly with any hospital-based billing system (Epic, Cerner, Artiva, Soarian, Meditech, Paragon, Star, Allscripts, and Invision). MedData has been performing revenue cycle management services for 40 years, and 100% of our business is in the healthcare industry. Our experienced and tenured team has been performing A/R recovery services for a variety of client types and sizes for more than 10 years. We have advocates, specialists, and leadership with expert knowledge of denials management, billing, guidelines, procedures, and compliance who are ready to respond to a hospital’s needs and meet its A/R goals.

Most of the payers you’ll find on Essentials offer real-time authorizations. Just start with the basic information, and we’ll pre-populate as many of the fields as we can, and in just a few minutes you’ll have an answer that’s straight from the payer. We’re also working with several leading payers to simplify the process even more, with a question-and-answer format rather than the on-screen forms. Our new dashboards let you quickly check the status of all the auths requested by your office. For selected payers, you can even provide unsolicited attachments that you know the payer will need for approval. Once the visit is over, it's time to start the paperwork that gets you paid: claims.

Processing insurance claims can be a labor-intensive task, involving extensive documentation, data entry, and manual effort. CampTek has an Intelligent Automation solution will do the following things:

• The integration of AI identifies problematic payors and claim types. These types of issues can be remediated via System configurations or through automation.   
• Larger more repetitive workflows can also be automated at scale.  
• This an end-to-end solution can be implemented to solve the issues with a claim before it is submitted but also as a continuous improvement of workflows.  

Automated Data Extraction and Transmission:

It will automate the extraction and transmission of data related to the insurance claim in any EHR/EMR, payor portal and clearing house. 

Unstructured data, such as handwritten notes or scanned documents, can be automatically extracted and organized and entered into an EMR/EHR, ERP System, payor portal or clearing house website. It’s accurate and consistent.  

Average Annual KPI’s for a Provider with $3B Annual Net Patient Revenue:

• Efficiency and accuracy increased by 48% 
• Accelerates reimbursement by 38% 
• Reduces rework and denials by 30%