Working with Denied Claims

This section provides guidance for billing teams, denial analysts, and RCM leaders on how to resolve denied claims efficiently using Revenue Recovery.

Revenue Recovery automates denial identification, root-cause analysis, and correction recommendations by integrating directly with your existing billing systems and EHR workflows. Whether your team works claims directly within your EHR/PMS or through the Revenue Recovery web application, the platform ensures a consistent, transparent, and audit-ready experience.

Overview

Revenue Recovery supports two complementary workflows for managing denied claims. Both methods use the same AI-generated insights and correction logic; the difference lies in how and where users interact with the recommendations.

Revenue Recovery is designed to complement—not replace—your existing systems. Both workflows deliver the same AI intelligence, ensuring users can choose the approach that best fits their daily operations.

Working Denials within Your EHR or PMS

The EHR/PMS workflow is the preferred approach for most billing teams. It allows users to take advantage of Revenue Recovery’s automation without changing their current processes or tools.

How it Works

• Embedded AI Recommendations Revenue Recovery automatically delivers AI-generated recommendations for each denied service line directly into the comment or note section of the claim in your EHR or billing platform.

• Streamlined Review When staff log in each morning, all denied claims include step-by-step recommendations outlining how to resolve each issue—eliminating the need for manual research or data extraction.

• Workflow Continuity Users can continue to work entirely within their existing systems, leveraging AI insights without additional logins or application switching.

Example Use Case

A billing analyst opens a denied claim in their EHR and immediately sees:

“Add modifier 59 for CPT 93306 per payer-specific guideline.”

This embedded recommendation accelerates claim correction and reduces time spent reviewing payer documentation.

Key Benefits

• Zero disruption to existing workflows
• Faster claim resolution and improved team velocity
• Consistent recommendations aligned with payer rules and policies

Learn more about working denials in your EHR →

Working Denials in the Revenue Recovery Web Application

The web application workflow provides enhanced visibility into AI performance, financial impact, and compliance history. It is most commonly used by team leads, RCM directors, and compliance reviewers who require detailed insight into denial activity.

The Claim Flow Page

The Claim Flow page within the Revenue Recovery web application offers a detailed, transparent view of how each claim was analyzed and corrected.

Core Capabilities

• AI Action Transparency View a chronological record of the AI’s actions, including extracted data, reasoning steps, and applied corrections.
• Feedback Loop Provide direct feedback by approving or rejecting AI recommendations using the thumbs-up/down feature. For each rejection, add a brief comment explaining the rationale. This feedback trains the AI and continuously improves its accuracy for future claims.
• Audit and Compliance Support The Claim Flow page logs all AI and user actions, providing an audit-ready trail for compliance teams.
• Corrected 837 File Generation The system can generate corrected 837 claim files for resubmission. While submission still occurs through your existing tools, these files serve as ready-to-review outputs for verification and documentation.

Example Use Case

An RCM Director logs into the web application to review denied claims for the week. By accessing the Claim Flow, they can confirm which recommendations were accepted, see associated AI confidence scores, and review comments left by analysts. This transparency helps validate AI accuracy and build trust across the team.

Key Benefits

• Full visibility into AI decision-making and claim history
• Feedback-driven learning to refine AI accuracy
• Audit-ready documentation supporting compliance and performance reviews

Learn more: Working Denials in the Revenue Recovery Web Application →

Choosing the Right Workflow

Key Takeaways

• Revenue Recovery integrates seamlessly into your existing RCM ecosystem, reducing manual effort and improving claim turnaround time.
• The EHR/PMS workflow maximizes efficiency for day-to-day users, while the Web Application workflow enhances visibility, compliance, and feedback loops.
• All actions remain human-in-the-loop, ensuring your team maintains full control and accountability.

Revenue Recovery accelerates claim correction and preparation. It does not automatically submit claims to payers. Claim submission and tracking continue through your existing billing or EHR systems.

Next Steps

Select the workflow that aligns with your role to learn more:

• Working with Claims in Your EHR/PMS
• Using the Claim Flow Interface