Denials Recovery

Prevent and overturn denials to boost revenue

R1 Denials Recovery is a full-service solution to recoup payment from commercial, government and managed care payers that have incorrectly denied or underpaid claims. Our clinicians, attorneys, certified coders and reimbursement analysts collaborate to appeal, recover and prevent denials using intelligent technology and advanced analytics to produce fast reimbursement and process improvement.

SPEAK WITH AN EXPERT

Transform Denial Management with AI-Assisted Appeals Generation

This video shows how R1’s AI-Assisted Appeals engine streamlines the appeals process, reducing clinician processing time and accelerating cash collection for hospitals.

This technology uses generative AI to create concise and accurate appeal documents, shifting the role of clinicians from authors to editors and reducing time per appeal from more than an hour to just 15 minutes.

Get full-service denials and appeals management to recover more

Quickly and efficiently resolve wrongfully denied or underpaid claims from commercial, government, military and Medicare/Medicaid Advantage payers. R1 Denials Recovery is a full-service denial and appeals management solution that recovers earned reimbursement payers inappropriately withhold or delay.

Resolve claims quickly

Begin generating revenue in as few as ten days with our industry-leading overturn rates driven by deep domain expertise and intelligent technology.

Partner with highly specialized experts

Our team of specialized subject matter experts serves as a powerful extension of your staff to do the heavy lifting on high-volume or specialized inventory while you focus on other high-priority, revenue-generating receivables.

Boost workflow efficiency

Work smarter with a single solution across all payers that offers a more efficient approach to account follow-up, resolution, and root cause identification and analysis for ongoing process improvement.

Ranked #1 by KLAS

We’re proud to be recognized for outstanding performance and customer satisfaction excellence in the new Denials Management Services category.

A+

Loyalty

A-

Operations

A+

Relationship

A

Services

A

Value

R1 is ranked #1 by KLAS® in Denials Management Services

I have enjoyed every one of the firm’s employees that I have engaged with from the team to the leadership and salespeople. The R1 team is highly engaged and supportive of our operations and success. We can rely on R1 to help us when we need additional assistance or expert review. They are an excellent business partner. I have appreciated their commitment to sharing the annual findings with my leadership, and they really are very good at educating my teams on what they find that might be preventable in the future. Our goal is to find some things on our own so that we don’t need the firm as a safety net, but we are very grateful that we have them as a safety net because we are not going to find everything.”

Denials Management Services KLAS Report, July 2024

VP/Executive

R1’s clinical and legal expertise and ability to craft an argument in the setting of a clinical denial is really powerful and fills a need that is often not internal at a healthcare organization, so that is nice to have for us. We have a great relationship with the individuals assigned to our account. There is a good camaraderie there and good back-and-forth collaboration. R1 is great. They have customized expertise, and that is hard to find. That is our favorite aspect of working with them.”

Denials Management Services KLAS Report, December 2023

Director

When I look at the reports, I see a lot of overturned appeals. Our expectation is to get the appeals paid. We are getting cash. R1 gets a lot of the appeals paid.”

Denials Management Services KLAS Report, Jan 2024

Analyst/Coordinator

The firm is incredibly collaborative. They are not there just to say they are going to collect. They seek to not only do the work but also help educate and improve processes with their clients. I really appreciate the collaboration that we have with the firm. Also, their processes are very efficient. They get the information and turn it around, and we see the return on investment from them. That is fantastic.”

Denials Management Services KLAS Report, August 2023

Manager

Keep improving for lasting success

Gain knowledge and insight for measurable performance improvements. Here’s a look at how we work together after defining your program with our risk-free Aged Trial Balance (ATB) assessment.

You can grant access to work queues in your system so we can begin working inventory immediately. We automate an assigned inventory file to maximize our service delivery and root cause identification capabilities.

Our Platform ingests the file of assigned accounts, prioritizing the highest value and most timely accounts. Our experts analyze and review payer contracts and state and federal regulations to resolve denied government and non-government claims. Credentialed experts review and begin resolving automated placements daily.

We correct issues on denied and unpaid claims, write clinical and technical appeals when appropriate, and then file them on your behalf to collect payment. We assign our staff attorneys and clinicians to participate in payer meetings to hold payers accountable for complying with contracts.

Robust reporting and root cause analysis equip you to better manage your workflow, team and ongoing training efforts. Our healthcare attorneys and clinicians assist you in your future payer contract negotiations, and we inform you of payer behavior patterns and trends. We also hold regular business reviews with your team.