With the Firstsource Denials Management solution, you get full-spectrum denial lifecycle management from prediction and prevention to prioritization, appeals, and recovery, helping you maintain high financial performance even during operational disruption.
Powered by decades of experience and cutting-edge AI, our solution delivers:
- AI-powered propensity scoring that prioritizes prevention where it matters most
- Claim-specific smart appeals generated through generative AI for faster resolution
- Automated workflows for triage, appeals, and A/R cleanup that accelerate cash flow
- Comprehensive analytics to reduce denial rates and recover lost revenue
- Tailored training programs powered by GenAI that empower your staff with best practices
We transform your revenue cycle through technology, data-driven optimization, and team enablement—reducing denials today while building proactive capabilities for tomorrow. The result? AI-first denial management with enterprise-scale execution and expert guidance that transforms your denial outcomes.
Comprehensive Denials Management and Prevention
Our three-pronged approach spans the end-to-end denials value chain, addressing prevention, mitigation, and management with measurable improvements to your revenue recovery performance.
Denials Prevention:
Root Cause Analysis & Proactive Intelligence
Strong analytics identifying root causes drive targeted improvements before denials occur. Our consultative services help payer clients with prioritized areas of improvement based on analysis, while automation in the front end and ML intelligence prior to claim submission prevent denials at the source. We implement process error proofing and provide comprehensive training and education to reduce denial rates from the start.
Value Delivered:
- Lower denial rate through predictive analytics
- Full Denials solution suite with comprehensive prevention
- Transparent Denials process with clear visibility
Denials Mitigation:
AI-Powered Propensity Scoring & Smart Routing
Identify the propensity for a claim to be denied before the claim is sent to the clearing house. Our AI-based collectability propensity prioritizes claims for follow-up/resubmission, while automated triage of denials routes claims to the right subject matter expert for resolution. AI propensity scoring ensures optimal resource allocation across your denial portfolio.
Value Delivered:
- Higher reimbursement rate through intelligent prioritization
- Increased Revenue with optimized claim processing
- Lower cost to collect through efficient routing
Denials Management:
Effective Appeal Process & Expert Resolution
An effective appeal process using subject matter expertise and intelligent automation drives successful outcomes. Our automated first pass appeals and AI propensity to overturn via appeal scoring maximize recovery rates. Subject matter expertise spans technical denials, clinical denials, coding denials, and legal/complex denials, while automated additional document request processes and AI-generated appeal letters based on payer policy streamline resolution.
Value Delivered:
- Reduction in AR Days through faster resolution
- Increased denial overturn rate with expert appeals
- Higher quality outcomes through specialized expertise
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