AI Powered Denial Prevention & Recovery Prioritization
Denova Claims Intelligence provides healthcare revenue cycle leaders with early visibility into denial risk and data-driven prioritization of denied claims, enabling smarter intervention without disrupting existing RCM workflows.
The Challenge
Denial management remains reactive and expensive.
Despite significant investment in RCM platforms, payer edits, and clearinghouse workflows, claim denials continue to represent a persistent source of revenue leakage for provider organizations.
Across industry forums and peer discussions, revenue cycle leaders consistently highlight common challenges:
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Limited early visibility into which claims are likely to be denied
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Increasing payer variability and complex, shifting edit requirements
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Denial workflows that surface issues only after submission
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Difficulty prioritizing recovery efforts across large denial volumes
As a result, teams are often forced to manage denials by volume rather than by value, spreading effort across repetitive, low-yield rework while higher-impact recovery opportunities compete for attention.
Our Approach
Denova introduces an intelligence layer before and after claim submission to support more informed decision-making.
Pre-Submission Risk Identification
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Identifies claims with elevated denial risk
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Surfaces payer-specific and historical risk signals
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Enables proactive correction prior to submission
Post-Denial Recovery Prioritization
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Prioritizes denied claims based on expected recovery impact
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Directs staff effort toward the most meaningful appeal opportunities
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Minimizes time spent on low-probability recoveries
Built for Existing Environments
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Complements existing RCM and clearinghouse systems
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No system replacement or workflow disruption
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Leverages standard claim data (837 / 835)
Operational Outcomes
Denova functions as a decision-support layer where Teams act on insights, not volume.
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Identification of preventable denial risk before submission
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More focused use of staff time on high-value recovery efforts
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Reduced rework and manual follow-up across low-yield denials
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Improved visibility into denial patterns and payer behavior
Who It’s For
For healthcare revenue cycle leaders and teams managing denial risk and recovery at scale.
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Hospital and health system revenue cycle leaders
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Organizations managing high denial volumes
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Physician groups and specialty practices
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RCM teams seeking efficiency and focus
Design Partner Program
Denova is engaging provider organizations as design partners to validate workflows and refine prioritization logic.
"No PHI sharing or system integration is required to participate."
Early design partner feedback will help shape how Denova Claims Intelligence supports denial prevention and prioritization in real-world revenue cycle environments.
Design partners benefit from:
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Early access to claims intelligence capabilities
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Direct influence on product direction
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Collaborative validation with peer organizations