AI Denials Management involves the identification, analysis, and resolution of denied claims to ensure that providers receive reimbursement for services rendered. Products in this category perform functions including:

• Recognizing claims that have been denied by the payer. This can be due to various reasons such as coding errors, incomplete information, or issues with patient eligibility.

• Investigating or understanding the reasons for denial. This often involves using AI to review claim details, patient records, and communications with the payer.

• Making necessary corrections to the denied claims and resubmitting them for approval. This might involve updating coding, providing additional documentation, or correcting patient information.

Given the need to interpret claims responses and automate them in many cases, there are strong connections between this category and products in Revenue Cycle Automation. Additionally, given that the goal of denial management is ultimately to reduce denials, many products in End-to-End Revenue Cycle Management also offer denials management workflows.