Denial analysts and billing specialists
What happened? Is action possible? What evidence supports it?
Healthcare Denial Intelligence & Decision Support
Turn denial data into evidence for action.
Connect claims, remittances, enrollment, eligibility and authorization data to investigate why revenue was denied, prioritize what needs attention and identify patterns that point to prevention opportunities.
Synthetic demonstration data only. No PHI.
From denial code to evidence
A denial code tells only part of the story.
An 835 remittance records that a payment was adjusted or denied, and the reason and remark codes the payer applied. On its own, it rarely shows whether coverage was active on the date of service, whether an authorization was on file, or how the claim as submitted relates to the outcome.
DenialIntel looks beyond the adjustment code, helping teams move from reporting what was denied to understanding what happened, what needs attention and what may prevent recurrence. It brings related transaction records together so teams can see what the record supports and decide whether action is possible.
The reason code alone
- The amount adjusted or denied
- The claim adjustment reason and remark codes
- The payer and the date of the remittance
With connected transaction evidence
- What was billed on the matching 837 claim
- What 270/271 eligibility responses reported around the service date
- Whether a 278 authorization response is on record
- Enrollment periods from 834 data
- How this denial compares with similar denials over time
Connected transaction intelligence
Five transaction types. One investigation.
Healthcare transactions are created at different points in the patient and claim lifecycle. They are separate records — not a processing pipeline — and, where available, each contributes evidence about what occurred.
Shown in lifecycle order: Enrollment — Eligibility — Authorization — Claim — Remittance
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834
Enrollment
Membership and coverage periods. Was the patient enrolled for the period in question?
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270/271
Eligibility
Eligibility inquiry and response. What did the payer report about coverage around the service date?
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278
Authorization
Authorization request and response. Was the service authorized, and for what?
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837
Claim
The claim as submitted. What was billed, for whom, by whom and when?
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835
Remittance
Payment and adjustment advice. What was paid, adjusted or denied, and with which reason codes?
Each record contributes evidence to denial investigation, where available.
From transaction to action
A workflow that moves denials from reporting to action.
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Ingest
Healthcare transaction data enters the workflow. In the public demo, synthetic data is pre-loaded and uploads are not available.
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Validate
Transaction and data validation checks identify incomplete or inconsistent records before analysis.
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Match
Claims are matched to remittances, linking each payment outcome to what was billed.
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Classify
Denials are identified and classified by reason, payer, department and other dimensions.
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Investigate
Analysts review claim, remittance, eligibility and authorization evidence for a denial.
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Prioritize
Worklists, ageing and priority analysis show which denials need attention first.
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Support Recovery
Evidence and prioritized worklists support the appeal, correction and follow-up work your team carries out.
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Identify Prevention Opportunities
Recurring patterns and likely contributing causes point to upstream processes worth reviewing.
Decision support at every level
Different roles ask different questions.
DenialIntel provides operational and financial decision support — not clinical decision support. It is designed to answer the questions each part of the revenue-cycle organization brings to denials.
Operational teams
Which process or upstream issue keeps producing this denial?
Revenue-cycle and finance leadership
Where is revenue being lost? What deserves management attention?
Product preview
See the evidence in context.
From management-level denial patterns to individual transaction evidence, DenialIntel keeps analysis connected to the records behind it.
Deterministic analytics, optional AI
Evidence before explanation.
DenialIntel's core rules, matching and calculations are deterministic and reproducible. Statistical and ML analysis add pattern and risk indicators, while AI provides optional explanation of established evidence.
Core
Established by deterministic processing, business rules and statistical analysis
- Transaction and data validation checks
- Claim-to-remittance matching
- Denial identification and classification
- Financial impact, rates, trends and ageing
- Priority analysis and worklists
Statistical and ML analysis highlight patterns and risk indicators to support review. They do not make decisions.
Optional
Explained by AI
- AI Insight: concise summaries of established findings
- AI Deep Dive: narrative explanation of a denial pattern or area
AI does not perform the core calculations, decide whether a claim must be paid or replace professional and payer-policy review.
People review the evidence and decide what action to take.
Explore DenialIntel with synthetic data.
Explore the working DenialIntel application using synthetic healthcare transaction data. No login is required, and no patient information should be entered.
Synthetic demonstration data only. Do not enter PHI or other sensitive personal information.