Denials Management

Turn denials into dollars with AI-driven recovery

R1 Denial Management’s AI-assisted workflows accelerate appeals, reduce denials and increase recoveries up to 15%.

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Denials Management that drives results

15%

more cash collected on average

90%

average denials overturn rate

10 days

to recover revenue

30 days

to return on investment

Our flexible denial solutions combine AI-assisted technology, advanced analytics and expert clinicians to recover more revenue and prevent future denials.

( 1 )

Technical denial management

Resolve authorization, eligibility, coding, COB and billing denials with AI-driven workflows and expert review.

( 2 )

Clinical denials and appeals

Get more thorough reviews and effective advocacy to help overturn unjust denials and improve financial health.

( 3 )

DRG and ED Downgrades

Identify and recover revenue from DRG and Emergency Department (ED) downgrades and downcodes with accurate coding and robust clinical justification.

( 4 )

Aged denials (EBO)

Recover cash from aged denials with full-service support with our extended business office (EBO) support.

( 5 )

One-time placements

Get help with specific denial challenges including cleanup work, system migrations and consultation/training.

R1 streamlines the clinical appeals process with AI-assisted automation

Appeals process

Traditional

R1 AI-assisted appeals

Finding opportunity

Traditional

Lengthy manual review

R1 AI-assisted appeals

AI triage agent segments data and gathers needed documentation

Draft the appeal

Traditional

Manual, up to 1 hour

R1 AI-assisted appeals

AI drafts the appeal, reducing time by 50% to just 20 minutes

Validation

Traditional

Manual research/revision

R1 AI-assisted appeals

Clinician-in-the-loop performs QA and drafts any changes

Submission

Traditional

Acquired experience

R1 AI-assisted appeals

Payer intelligence selects the best path, format and payer-specific data to streamline submission

Follow-up

Traditional

Manual calls or checks

R1 AI-assisted appeals

Autonomous follow-up

Case Study

$40M recovered in one year for large multi-department hospital

A hospital with $1B+ in revenue piloted R1’s solutions. After recovering more than $293K in 25 cases, R1 became the sole vendor, recovering $40M in one year with 100% appeal coverage.

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Two professionals wearing headsets collaborate while reviewing paperwork together in an office.

Autonomous follow-up for back-end revenue cycle performance

Part of Phare Flow

Phare Flow doesn’t just follow up—it follows through. From claim submission until payment, intelligent agents work as a team alongside humans to manage claim status checks, denials, escalations, credits and adjustments at scale. R1 brings unmatched payer connectivity, data and influence to help drive open AR down to zero.

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