Clinical Denials

When your resources are limited, it’s a struggle to bring ROI to your clinical appeals. At Knowtion Health, we bring a diversified bench with unique strengths and credentials - industry, medical, and legal certifications, including dedicated nurse teams with utilization review and case management experience. Using a customized appeals process, on average, we overturn 65% of the medical necessity and no authorization denials.

We have teams who’ve also worked on the payer side of healthcare, which gives us the inside track to insurance claim resolution and allows the system to work with us, instead of against us. We often attend payer meetings with our clients and bring account examples to share with the payers who are denying in error.

In addition, we have a dedicated, certified billing and coding team. We’ll also provide reporting and staff education specific to the trends and root causes so they can be corrected sooner to reduce future denials.

Your goal is always to generate the best ROI at the greatest efficiency. If you are submitting canned denials, you’re likely overturning less than 30%. Knowtion Health can help you increase those rates on average to 65% using our dedicated team and customized appeals process. That’s additional ROI that adds to the bottom line and doesn’t result in lost revenue.

You’ll also save by reducing write-offs by winning more appeals and reducing capital technology investments knowing that ClaimBRAIN, our AI enabled technology and machine learning, are being used to work your accounts.

With our robust reporting, providing not only placement and revenue reporting, but also trending information on root cause and payer trends, Knowtion Health ensures you know what’s happening with your inventory.

We also provide complimentary educational training specific to your denials and payers, to help you improve processes and reduce future denials.

If you’re only recovering 30% of your clinical denials, it’s contributing to the aging of your A/R.

Rely on the Knowtion Health team to get your clinical claims appealed and overturned. This will allow you to not only achieve the revenue on paid reimbursements but also allocate employees working these accounts to more profitable work.

We have a nimble implementation process, are equipped to work with any hospital-based billing system, and use ClaimBRAIN, equipped with AI appeal assistant to write, track and enhance payer appeals. 

We have a dedicated, skilled team who triages your account to identify problems, improve processes and resolve denials. Using a customized appeals process, on average, we overturn 65% of the medical necessity and no authorization denials.