Claim denials are draining revenue, straining teams, and putting pressure on the entire revenue cycle. Here’s a look at what’s driving the rise in denials and how the right technology can help stop them before they start.
of providers pinpoint front-end workflows as the top contributor to denials.1
of healthcare executives state claims denials are a top challenge in their organization.1
Top four reasons claims get denied:
- Missing or incorrect patient info
- Lack of authorization or pre‑certification
- Eligibility/coverage not verified
- Submission errors
(codes, modifiers, and timing)
Fix the Cause, Not Just the Symptoms
The root cause of denials happens earlier in the process than many realize, but the right technology can make all the difference.
Rules-based automation
Start strong with batch verifications and insurance discovery that reduces manual work, surfaces missing coverage, and keeps claims moving forward.information for each patient and claim.
Workflow enhancement
Help your teams work smarter, not harder by automating manual tasks, prioritizing urgent denials, and giving staff more time to focus on recovering revenue.
Root-cause denial analytics
Understand the real drivers behind denials, like missed payer rules and submission errors, so you can catch issues early and prevent them from recurring.
Ready to Fight Back Against Denials?
Explore how Inovalon’s revenue cycle management solutions help stop denials before they start.
- “Claims Denials: Causes, Impact, and AI-Enabled Prevention Strategies,” Inovalon, October 2024, https://www.inovalon.com/resource/claims-denials-causes-impact-and-ai-enabled-prevention-strategies/
- “Exploring AI’s Role in Revenue Cycle Management,” Inovalon, July 2024, https://www.inovalon.com/resource/exploring-ais-role-in-revenue-cycle-management/
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