Claim Denial Prevention
From Registration to Reimbursement — Building a Denial-Free Workflow
Stop chasing denials and start preventing them before they start. Proactive intervention across the revenue cycle to ensure claims are accurate, complete, and compliant before submission.
Prevention vs. Management
Claim denial prevention is fundamentally different from denial management. Denial management resolves claims after they are denied, while denial prevention stops denials from happening in the first place.
This program focuses on proactive intervention across the revenue cycle to ensure claims are accurate, complete, and compliant before submission — transforming denial handling from reactive firefighting into strategic prevention.
The Denial Challenge
Follow the claim journey — see where revenue leaks and where prevention wins
Submitted
All claims
Denied
Every 5th claim
Never resubmitted
Revenue walks away
Preventable
That's the opportunity
20% of claims denied
Industry average
60% never resubmitted
Permanent loss
65% preventable
The opportunity
Major denial causes
Most denials stem from issues that can be caught before submission:
- Missing or inaccurate data
- Authorization and pre-cert issues
- Eligibility errors
- Coding errors
- Medical necessity documentation
Financial Impact
$3 Trillion
Total claims submitted annually
$262 Billion
Total denied claims
$5M/Year
Average impact per provider
$170 Billion
Lost annually (never resubmitted)
Industry Data
- check_circle Average denial rate: 8.7%
- check_circle Some organizations report rates above 15%
- check_circle 75% of providers seeing denial increases
- check_circle 89% actively seeking technology solutions
Cost of Rework
- paid Typical cost to rework a denial: $25–$117
- paid National average: $72.50 per denial
- paid Average cost to submit a claim initially: $6.50
- 100 denials/month ≈ $30,000/year in recovery costs alone
Core Capabilities
Real-Time Error Detection
Advanced AI and machine learning identify claim issues before submission and guide resolution.
Embedded Staff Education
Instant feedback and coaching tools help staff learn from errors and improve performance over time.
Workflow Integration
Seamless integration across departments improves accuracy and operational efficiency.
Performance Intelligence
Actionable insights help organizations build long-term proficiency and reduce denial rates system-wide.
Strategic Outcomes
- check_circle Up to 50% reduction in preventable denials
- check_circle Faster clean claim submission
- check_circle Reduced rework and staff burnout
- check_circle Improved denial KPIs and compliance metrics
Business Impact
The program shifts organizations from reactive denial response to proactive financial protection by combining predictive analytics, real-time validation, and staff collaboration.
The result: a smarter, more efficient revenue cycle that protects revenue and strengthens operational performance.
Platform Strengths
A solution proven across hospital systems
Stop Chasing Denials, Start Preventing Them
Transform your revenue cycle from reactive firefighting into strategic prevention. See how Claim Denial Prevention can protect your revenue.