HealOS transforms denial management from a reactive "fix it later" workflow into a proactive denial prevention engine. AI Agents analyze claims in real time, detect risks, correct errors automatically, and prevent up to 75% of denials before submission, improving cash flow, boosting clean claim rates, and eliminating costly rework.
Most healthcare organizations manage denials reactively—fixing issues after claims are rejected. This approach leads to revenue loss, administrative burden, and delayed payments. HealOS transforms this into proactive denial prevention.
| Challenge | Impact | HealOS Solution |
|---|---|---|
| Reactive denial management | Revenue loss, delayed payments | Proactive denial prevention before submission |
| Coding & documentation errors | Claim denials, rework | AI-powered real-time claim scrubbing |
| Eligibility & authorization gaps | Preventable denials (~40% of all denials) | Automated eligibility & PA validation |
| Manual appeal preparation | Time-consuming, slow recovery | Automated appeal generation & submission |
| No predictive insights | Repeated denial patterns | AI predictive analytics & root cause analysis |
Comprehensive AI automation that prevents denials before they occur and resolves them faster when they do.
AI evaluates claim patterns, payer rules, and past outcomes to predict denial risk and flag claims needing correction before submission.
Advanced scrubbing reviews coding, modifiers, documentation, payer formats, and policy rules to guarantee clean, compliant claims.
HealOS checks coverage, in-network status, benefit limits, deductibles, and service rules to eliminate eligibility-related denials (≈25% of all denials).
AI identifies required authorizations, gathers documentation, submits PAs, and monitors approvals to prevent authorization-related denials.
AI reviews clinical notes and coding patterns, flags mismatches, and ensures every billed service meets documentation and payer criteria.
AI validates required elements, missing signatures, medical necessity details, and attachment requirements before claims are submitted.
AI fixes invalid formats, demographic mismatches, outdated codes, broken code sets, missing modifiers, and order/resolution errors.
AI organizes claims by financial impact, urgency, denial probability, and submission deadlines for maximum efficiency.
AI identifies systemic issues across service lines, departments, and payers reducing recurring denials long-term.
AI drafts payer-specific appeals with clinical evidence, gathers documentation, and submits via automated workflows.
Models improve as they process more claims, continuously identifying new denial patterns and improving prediction accuracy.
Monitor denial trends, high-risk claims, payer behavior, and financial impact in real time.
A step-by-step automated workflow that prevents denials before claims are submitted.
AI reads clinical notes, coding patterns, eligibility details, and payer rules in real time. It flags missing documentation, incorrect codes, expired coverage, or authorization gaps before a claim is generated.
HealOS compares every claim to payer-specific policies, format rules, medical necessity criteria, coding edits, modifier requirements, and filing timelines to ensure first-pass accuracy.
Predictive analytics scores each claim based on denial probability. AI highlights issues, coding mismatches, invalid coverage, and missing PA, so your team can fix errors before payers reject the claim.
The system resolves common issues such as missing modifiers, demographic mismatches, duplicate entries, invalid formats, and order errors. Only complex cases require human review.
AI confirms that: Prior authorization exists, Coverage is active, Deductibles, benefits, and plan limits apply, Provider is in-network. This prevents ~40% of common preventable denials.
Once validated, HealOS submits clean claims to clearinghouses or payer portals, ensuring full compliance with payer rules, formats, and documentation requirements.
HealOS tracks every claim across portals, clearinghouses, and payer systems. It identifies pending issues, requests for information, and potential delays long before denial occurs.
AI drafts payer-specific appeal letters, attaches supporting clinical documentation, and submits appeals automatically, recovering revenue faster and reducing staff workload.
Every approval, denial, and appeal strengthens the model. HealOS continuously adapts to payer behavior, coding trends, and regulatory changes, making denial prevention more accurate over time.
Transform your revenue cycle with intelligent automation that improves financial performance, reduces errors, and enhances operational efficiency
AI Agents detect and resolve issues at the point of coding and documentation, preventing denials before claims reach the payer.
AI eliminates manual rework, appeal drafting, and portal navigation, cutting administrative labor and reducing revenue leakage.
Cleaner claims mean quicker reimbursements and 5–10 day improvements in A/R, improving financial predictability.
Automation removes repetitive tasks, freeing RCM teams to focus on complex claims, patient issues, and high-impact cases.
AI ensures claims include correct codes, valid documentation, and payer-required elements reducing compliance risk.
Root-cause analytics help leadership identify patterns, improve workflows, and strengthen payer negotiations.
AI handles large volumes across multi-location networks and hospitals without adding headcount.
Prevent high-volume coding and authorization denials across orthopedics, cardiology, oncology, GI, neurology, and behavioral health.
AI supports enterprise-scale denial prevention with complex multi-department workflows.
Centralized denial prevention ensures consistent accuracy across all sites.
AI eliminates manual investigation, coding reviews, and appeal preparation.
HealOS predicts denial risk, corrects issues automatically, and eliminates preventable denials before claims are submitted.
Seamless integration with Epic, Cerner, Athena, Availity, Waystar, and major payers enables automated claim validation and tracking.
AI enforces payer rules, updates automatically, and ensures documentation, codes, and formats meet compliance standards.
AI handles scrubbing, eligibility verification, prior authorization checks, and appeal drafting, reducing manual workload by up to 80%.
Health systems using HealOS achieve 20–40% lower denial rates, 25% cleaner claims, and millions in recovered annual revenue.
"HealOS completely transformed our denial management workflow. We went from reactive denial management to proactive prevention. Denials dropped by 75%, and our clean claim rate improved dramatically. The AI catches issues before they become problems."
"The predictive analytics and automated claim scrubbing have been game-changers. We're preventing denials before submission, and when they do occur, the automated appeal process recovers revenue faster than ever. ROI was immediate."
"Manual denial management was overwhelming our team. HealOS automated eligibility verification, prior authorization checks, and appeal drafting. Staff efficiency improved, and we eliminated hours of repetitive work."
Everything you need to know about AI-powered denial prevention and management
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