An End-to-End Denials Management Solution

A solution that addresses every step of the Denials Management process: analysis, preventative measures, work prioritization, user engagement via digital assistant, automated appeal and resolution submission, and end user education.

How does it work?

Below is an example of how our solution may react to different denial types at your organization. Some denials require improvements in the EHR to prevent the denial in the future. Some can be 100% automated after being posted. Others may require user input to determine the correct resolution path, and our digital assistant kicks in here to educate the user and then allow them to select the right automation for the given claim.

Automation

  • Based on Rotera’s analysis, we will recommend and implement high impact automations. If an automation can resolve a denial, why spend valuable employee time on it? Save the complex tasks that require human nuance for your team members, let Rotera take on large volumes of repetitive work.

  • We monitor the automations and their success rate, working with the end user to recommend tweaks to make or new automations to implement. We want our product to change the way your organization works for the better. In order to help you become the best, we need to evolve with you.

Analysis

  • Rotera’s denials insights are powered by machine learning, leveraging ML’s strong powers across large and complex datasets to identify how to best resolve a denial.

  • Our analysis provides more than just trends in denial types. We provide actionable insights to resolve denials fast. We also provide recommendations on upstream process improvements (EHR and process changes) to avoid denials in the first place. We believe the ultimate goal is to reduce denials, but we also understand that payer behaviors constantly change, denials are inevitable, and knowing how to quickly resolve a discrepancy to maximize reimbursement and reduce A/R is key to operations.

  • Understanding what work needs to be done is the first step. Completing it is the second. Rotera prioritizes denials resolution for both our bots as well as your team members, focusing on hitting highest impact accounts first while not leaving low balances on the table. Take the guesswork out of working denials.

Digital Assistant

  • As mentioned earlier, denials management is a process that should evolve as bots and humans learn about trends and successful resolution steps. We believe that education around denials is crucial for your team members as the information is constantly changing. Our digital assistant provides valuable insight as your end users are working denials to help guarantee accurate resolution.

  • Not only does the digital assistant equip the end user with education, but also with the ability to review data and progress related to the entire solution: automation progress, denials resolution rates, processes leading to repeat denials, and more. The user also has access to update accounts, initia e an autonomous task, and enable/disable automationsdirectly from the assistant.