Working Denials in Your EHR

The EHR workflow enables billing specialists and denial analysts to resolve denied claims using Ailevate Revenue Recovery’s AI-generated recommendations directly within their existing billing or electronic health record (EHR) systems. This approach eliminates the need to log into an additional platform, helping teams maintain continuity while improving efficiency and accuracy.

Overview

Ailevate Revenue Recovery integrates seamlessly with your EHR to deliver AI-powered claim recommendations where users already work.

Each morning, as billing staff log into their EHR, denied claims include clear, line-level recommendations explaining how to correct each issue. This allows analysts to immediately begin resolving denials without additional research or system changes.

This workflow is ideal for billing and denial management teams focused on daily denial correction and turnaround time improvement.

How It Works

1. Generate Recommendations

Ailevate Revenue Recovery continuously ingests and analyzes:

• 835 and 837 EDI files to identify claim-level and service-line denial details.
• Denial codes (CARC/RARC) that indicate why each claim or service was rejected.
• Relevant patient and encounter information from your connected EHR to ensure recommendations reflect accurate clinical and billing context.

The AI combines these data sources to generate correction recommendations for each denied claim. These recommendations appear directly in the comment or notes section of the corresponding record in your EHR, giving your team clear next steps without additional tools.

2. Review and Apply Corrections

Analysts review each recommendation alongside patient documentation, payer information, and other claim details in the EHR. Each recommendation provides specific, actionable guidance to help users resolve the denial efficiently while maintaining compliance with internal policies.

3. Update and Resubmit

After validating the recommendation, analysts make the necessary updates directly in their EHR, generate a corrected file, and submit it through their standard workflow.

Example: For a denied echocardiogram claim, Ailevate Revenue Recovery may recommend: “Add modifier 59 for CPT 93306 based on service-level review.” The analyst can confirm the modifier aligns with clinical documentation before resubmitting.

Key Benefits

• Familiar environment – Continue working within the same EHR your team uses today.
• Faster review process – Begin each day with denied claims that already include detailed guidance for correction.
• Data-enriched insights – AI combines claim, denial, and patient data for contextually accurate recommendations.
• Minimal workflow disruption – No new system access or separate logins required for daily users.

Best Practices

1. Verify all recommendations before applying corrections. Always confirm AI-suggested updates align with payer requirements and internal compliance standards before resubmitting.

2. Escalate feedback through your team lead. If a recommendation appears inaccurate or incomplete, note the issue internally. Team leads or designated reviewers with access to the Ailevate Revenue Recovery web app can log formal feedback to help improve future AI accuracy.

3. Use the web app for advanced insight (if available). Teams with access to the Ailevate Revenue Recovery Claim Flow Page can view detailed Claim Flow information or review claims sorted by denied amount and status for additional context.

• Using the Claim Flow Interface

Workflow Summary

Key Takeaway

Working denials directly within your EHR allows your team to leverage Ailevate Revenue Recovery’s intelligence without changing systems or disrupting workflows. By combining payer data, denial codes, and EHR patient context, Ailevate Revenue Recovery enables more accurate corrections and faster denial resolution—all while keeping your team in their familiar environment.