AI Denials Management
Predict. Automate. Recover.
Med-Metrix’s AI Denials Management platform is a proprietary solution built to conquer modern denial challenges with precision, automation, and clinical intelligence. Designed using advanced machine learning, large language models (LLMs), and payer-specific training data, it predicts overturn probability, streamlines appeals, and maximizes recovery—fast.Our system intelligently classifies denials, recommends the best appeal strategy, and automates the process from end to end. With AI-generated appeal packets informed by payer requirements, clinical criteria, and adjudication workflows, every submission is strong, complete, and compliant. Each packet includes a custom appeal letter, curated sections of the medical record, and all required attachments.
We go beyond automation—this is strategic optimization. Our models are trained on hundreds of thousands of payer-specific denials and incorporate legal, regulatory, and coding rules to boost accuracy and ensure compliance. Denial pathways are optimized by appeal type, user performance, and payer behavior to increase overturn rates and streamline case assignment.
Powerful Tech. Proven Results. Denials Don’t Stand a Chance.
Our platform connects to patient accounting systems, EMRs (via FHIR), EDI, case reviews, and payer portals via RPA. It verifies EDI benefits and auth, retrieves documents, and automates submission through APIs, bots, and print-to-mail solutions. Inbound correspondence is processed with AI-powered OCR to auto-initiate denial workflows and update case statuses in real time.
Comprehensive reporting provides real-time visibility into overturn rates, submission velocity, and payer adjudication trends. Automation and user workflows are continuously optimized to increase yield, accelerate resolution, and reduce manual effort.
Battle-tested and proven, Med-Metrix’s AI Denials Management has adjudicated hundreds of thousands of claims—delivering measurable revenue lift for healthcare providers nationwide.
WHAT YOU CAN EXPECT:
Increased Overturn Rates through AI-driven appeal strategy, routing, and clinical intelligence
Faster Recovery with fully automated appeal submission, tracking, and follow-up via APIs, bots, and mail
Complete, Compliant Appeal Packets generated automatically with payer-specific letters, clinical documentation, and attachments
Optimized Work Distribution by predicting success probability by user and appeal type
Actionable Denials Reporting to track financial impact, adjudication timelines, and payer performance
Proven Financial Lift backed by hundreds of thousands of adjudicated claims and payer-trained models
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