DENIALS & REVENUE INTEGRITY SERVICES

Better denial outcomes, not just more denials worked

We find what's behind the denials, fix the root-cause, and get the rest filed on time.

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Trusted by 1,250+ Hospital Facilities and Physician Groups Nationwide

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Working the denial is only half of the job

Every denial tells you something. We look for patterns across payers, departments and denial types to determine what's really driving them - including clinical validation denials, which require real clinical expertise to win, not just an appeal letter. You get relief now and fewer repeat denials later.

Denial management and revenue integrity, across coding and clinical validation

  • Clinical validation and DRG downgrade defense
  • Pre-bill charge capture validation review and reconciliation, to catch missed or inaccurate charges before they become denials or lost revenue
  • Technical denial resolution - eligibility, authorization, timely filing and other non-clinical denials
  • Root-cause analysis across payers, departments and denial types
  • Validation of AI-assisted denial workflows and output
  • Revenue integrity program assessment, design and implementation


How we help

Additional capacity from a single open role to a fully managed team, working the most time-sensitive denials first.

We can manage your full denials program, leadership, coverage, quality oversight and reporting or take on a defined piece of it.

An independent assessment that looks at root-cause analysis across payers, departments and denial types to find those that are preventable, workflow and staffing, and shows where to focus first.

We check the AI output: validate accuracy and compliance, find patterns it may miss and where it needs a second look or adjustment.

 Targeted coding and documentation education based on the denial trends we're seeing, not generic curriculum. 

WORKING TOGETHER

Denials worked by priority.  Reporting to show impact and improvement.

Our Promise

  • Prioritization by deadline, dollars and likelihood of success
  • Regular reporting on what we've worked, appealed and corrected
  • Denial patterns and root causes, with recommendations to prevent repeats
  • When payer response data is shared, tangible ROI models can be built helping you understand the impact of our partnership and payer relationships.


Recovering Millions Hidden in Smaller Denied Claims

When a denials backlog grows faster than your team can work it, the real risk isn't just the volume.


It's recoverable revenue slipping away as filing and appeal deadlines approach. See how a nonprofit, multi-hospital health system partnered with UASI to work through more than 30,000 professional coding denials and correct $3.2 million in charges in less than 90 days.


What's inside:

  • Why a specialized coding denial managed service was the right fit for the backlog
  • How prioritizing the highest-risk, most time-sensitive denials protected at-risk revenue
  • How root-cause analysis gave leadership a clear view of where to focus prevention efforts


The result:

$3.2 million in corrected charges and an estimated 23:1 value-to-fee ratio, with unrecoverable loss limited to about $147,000.

$3.2M in Charges Corrected

in Under 90 Days


Download the case study to learn more!

FAQs

  • Do you handle clinical validation and DRG downgrade denials?

    Yes. These cases warrant RN/LPN clinical review rather than a strictly administrative appeal. Clinical expertise is needed to thoroughly evaluate the patient’s clinical picture, documentation, and supporting evidence and to develop a clinically sound appeal strategy.


  • Where does AI fit into denial management?

    AI can accelerate the process by sorting, prioritizing, and identifying patterns, but it is not a substitute for clinical expertise. Clinical review is critical to validate AI-generated insights, interpret clinical nuances, and support the most accurate and defensible outcomes.

  • Is charge capture part of denial management?

    Yes. Charge capture is a critical upstream component of revenue integrity, helping prevent denials before claims are submitted while complementing downstream appeals and root-cause analysis.

  • Is it more cost-effective to work denials in-house or with a partner?

    Comparing staff salaries to a vendor fee doesn’t give the full picture.  A fair comparison starts with the fully loaded cost of working denials in-house.  This takes into account the cost of:

    • Recruiting, onboarding and benefits
    • Ongoing supervision
    • Ongoing training on changing payer rules
    • The range of experience and credentials the work requires (RN, coder, revenue specialist)
    • Denial tracking, analytics and reporting tools
    • Downtime from vacancies and leaves, impacting the backlog and timely filing

    But you need to consider the overturn rate. Denials that age past timely filing and appeal deadlines often get written off. In addition, staff sometimes spends time on low-value appeals while high-dollar ones wait. Are the root causes being addressed or do you keep receiving the same denials month over month?


    The real measure is what each approach recovers and prevents for what it costs. In one recent backlog project, the value we recovered for our client was more than 20 times the fee.