Denial Management Services That Recover Revenue Faster

Claim denials are a growing challenge for healthcare organizations, costing over $262 billion annually. With over 33% of hospitals facing denial rates exceeding 10%, efficient denial management isn’t optional—it’s critical.

At SolvEdge, we combine advanced AI tools, actionable insights, and industry expertise to help healthcare organizations reduce denial rates, recover lost revenue, and maintain positive cash flow.

  • ✓ Reduce Denial Rates
  • ✓ Improve Cash Flow
  • ✓ Protect Your Bottom Line
Healthcare Professional
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The Cost of Ineffective Denial Management

Struggling with claim denials? Here’s how it impacts healthcare organizations:

  • $262 billion in claims are denied annually in the US
  • Preventable denials account for 3% of net patient revenue
  • Reworking denied claims costs $118 per claim, adding to administrative burdens

Why Leading Healthcare Providers
Choose SolvEdge

SolvEdge takes a proactive approach to denial management, going beyond just resolution to focus on prevention, recovery, and compliance

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Proven Expertise

Over a decade of experience helping hospitals and clinics reduce denial rates by up to 50%

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AI-Driven Solutions

Leverage cutting-edge tools like ZO for faster, smarter denial resolution

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End-to-End Support

From root cause analysis to denial prevention strategies, we’ve got you covered

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Custom Insights

Real-time analytics tailored to uncover and eliminate revenue leakage

SolvEdge's denial management services workflow

1

Denial Identification

Denial identification involves promptly detecting every denial to ensure timely denial follow-up and reduce the risk of revenue loss from unresolved denials. Accurate denial identification is critical for starting the denial management process effectively.

2

Denial Categorization

Denial categorization classifies denials by denial type and reason, allowing denial teams to prioritize high-impact denials and streamline denial resolution efforts. Effective denial categorization helps focus resources on the most common and costly denials.

3

Denial Analysis

Denial analysis investigates the root causes of denials, enabling denial managers to develop targeted strategies that prevent future denials. Comprehensive denial analysis turns denial data into actionable insights for continuous denial reduction.

4

Denial Appeals Management

Denial appeals management prepares and submits thorough appeals to overturn denials and recover denied payments, ensuring denial recovery is maximized. Skilled denial appeals management significantly improves overall denial resolution success rates.

5

Process Improvement in Denial Management Services

Denial process improvement focuses on refining denial workflows and providing staff training based on denial trends to minimize recurring denials. Consistent denial process improvement leads to a sustainable reduction in denial volume.

6

Performance Monitoring of Denial Management

Denial performance monitoring tracks denial rates and resolution timelines, offering key metrics to measure the effectiveness of denial management initiatives. Ongoing denial performance monitoring allows for timely adjustments in denial strategies.

7

Technology Utilization in Denial Management

Denial technology utilization leverages advanced denial management software to automate denial tracking, reporting, and payer communication for faster denial resolution. Integrating denial technology is essential for scaling denial management efforts efficiently.

Key Features of SolvEdge Denial Management

Our denial management services are built to drive results. Here's how we help you succeed

Root Cause Analysis

Identify the top reasons behind claim denials and implement targeted interventions to prevent recurrence.

AI-Assisted Denial Management

Automate denial processes to recover revenue faster and reduce claim rework cycles with our advanced AI solutions.

Compliance Assurance

Minimize risks with insurer-specific billing rules and proactive regulatory adherence.

Meet ZO: Your Denial Management Assistant

  • Advanced data analytics to uncover denial patterns
  • Predictive tools to prevent future denials.
  • Real-time dashboards to track recovery progress.

The SolvEdge Advantage

Partner with SolvEdge to experience transformative results

Before SolvEdge
High claim denial rates
Revenue leakage
Manual, error-prone processes
Reactive compliance approach
Limited visibility into performance
After SolvEdge
Optimized claim acceptance
Maximized revenue recovery
Automated, accurate workflows
Proactive compliance management
Data-driven decision-making

Results That Speak for Themselves

With SolvEdge, healthcare organizations have achieved

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Client Testimonials

“SolvEdge transformed our denial management process, saving us over $2M in just six months!”

CFO
Leading Healthcare Provider

Discover Your Denial Impact

Use our Denial Calculator to evaluate how much revenue you could reclaim with SolvEdge’s services

FAQs – SolvEdge Denial Management Services

Denial management is the process of identifying, analyzing, and resolving medical claim denials from insurance payers. An effective denial management service aims to minimize revenue leakage and improve the overall reimbursement cycle.

There are two main types of denials:
  • Hard denials: Permanent denials that cannot be reversed without an appeal.
  • Soft denials: Temporary denials that can be corrected and resubmitted. Common causes include authorization issues, coding errors, and missing documentation.

Typical scenarios in medical billing denial management include:
  • Incorrect coding
  • Missing prior authorization
  • Incomplete or inaccurate documentation
  • Timely filing issues
  • Services not covered under the patient's plan
SolvEdge’s denial management service helps prevent and resolve these issues efficiently.

The three most frequent claim errors are:
  • Incorrect patient information
  • Improper CPT/ICD-10 coding
  • Missing or invalid prior authorizations
SolvEdge Denial Management helps providers eliminate these root causes using intelligent automation.

A medical denial specialist works to:
  • Analyze denial reasons
  • Correct claim errors
  • Coordinate resubmissions and appeals
  • Ensure compliance with payer rules
At SolvEdge, our denial management experts ensure faster resolution and higher claim recovery.

To appeal no-authorization denials:
  • Confirm the reason with the payer
  • Collect supporting clinical and documentation evidence
  • Submit a formal appeal within the payer’s timeline
SolvEdge’s team handles the entire appeals process to recover lost revenue quickly.

SolvEdge Denial Management uses the 4Clover Approach:
  • Analyze claim denial patterns
  • Strategize using denial trend data
  • Discover workflow gaps and process lags
  • Implement corrective actions for long-term prevention

ZO is our proprietary denial management software that combines predictive and comparative analytics to categorize denials, assign root causes, and automate workflows for faster resolution. It's a core part of SolvEdge's denial management service.

SolvEdge denial management services are ideal for:
  • Hospitals and health systems
  • Independent physician practices
  • Specialty clinics (Ortho, Behavioral Health, etc.)
Our tailored solutions scale to your organization's size and payer mix.

We ensure every claim adheres to:
  • CMS and HIPAA regulations
  • Commercial and federal payer guidelines
  • Timely filing and documentation standards
SolvEdge continuously monitors updates in payer policies to maintain full compliance and minimize denials.