Change Healthcare Denials and Appeals Management offers services and technology to help healthcare providers manage and reduce claim denials. It includes identifying and analyzing the root causes of denials, handling appeals with expert assistance, and managing payer audits. It features detailed reporting to provide insights into denial trends and recommendations for process improvements, aimed at enhancing clean claim rates and reducing the administrative burden on staff.

Crosby Health offers a platform tailored for hospitals and health systems to manage clinical denials and appeals effectively. They use advanced language models to analyze provider documentation and generate arguments for medical necessity. The platform automates appeal processes, reducing manual entry and facilitating a unified submission to insurers. Crosby Health also provides detailed reporting on clinical denials, helping organizations track the financial status and productivity related to appeals management.

Datavant Denial Management offers a solution designed to help healthcare organizations reduce claim denials and optimize reimbursement, and includes tools for identifying and analyzing denial patterns, resolving denials, and submitting appeals. It offers analytics and services to provide insights for preventing future denials and improving clinical documentation and coding specificity.

Etyon provides AI-enabled solutions for optimizing revenue cycle management in healthcare. Their offerings include data integration, denial management, insurance payment risk prediction, patient payment risk prediction, contract management, labor optimization, and treasury management. Etyon's tools enhance performance tracking, predict and manage financial risks, and ensure accurate reimbursements through data analytics and ML capabilities.

Experian Denial Management helps reduce claim denials and improve reimbursements through automation and analytics. The product uses ERA and claim status transactions to identify and manage denied, suspended, pending, or lost claims. It provides detailed insights and reporting to pinpoint root causes of denials. Customizable worklists and ANSI reason codes facilitate more efficient claims follow-up and resolution.

RevFind detects and recovers underpayments from payers by reading healthcare provider contracts and comparing actual payments to contract terms, automatically flagging discrepancies. RevFind also provides detailed reporting and benchmarking against national standards, and supports ongoing recovery efforts with professional resources and strategic guidance.

MedMetrix Denials and Revenue Recovery focuses on handling claim denials and recovering lost revenue. Utilizing AI and automation technologies, MedMetrix offers pre-claim coding analysis, pre-billing reviews, and detailed case management support to prevent denials. Their system predicts the types of appeals most likely to succeed and automates these appeals. They also identify and recover underpayments and lost charges, handling both large and small dollar claims.

Rivet Claim Resolution helps manage claim denials with customizable worklists, easy filtering, batch workflows, and tailored denial processing documentation. This platform speeds up the appeals process by providing timely filing alerts and supporting bulk appeals. Rivet integrates seamlessly with EHR and practice management systems.

Rivet Payer Performance centralizes payer contracts and automates the detection of payment variances. The tool offers payer rate comparisons, contract storage, and renewal management. It enables users to model contract terms for negotiation, identify underpayments quickly, and streamline recovery processes through detailed reporting and analytics.

Sift Healthcare's Denials Management uses AI to prioritize claim denials by scoring them based on the likelihood of being overturned and paid, helping focus resources on promising denials, improve denial overturn rates, and accelerate cash flow. They also offer a Claims Edit Engine that uses historical payments data to prevent future denials through payer-specific claim edit recommendations.

Waystar Denial Management automates identification, analysis, and appeal of denied claims. It provides real-time insights into denial patterns, enabling healthcare organizations to address and prevent future denials. The system also supports streamlined workflows for submitting appeals and tracking their status, helping to recover revenue more effectively.