AppRev, a company that provides business intelligence (BI) solutions for healthcare providers, has launched Denials Intelligence, a cloud-based BI solution that identifies time-sensitive claim denials and prioritizes them for hospitals and physicians.

"[The solution] gives hospitals and physicians an intelligent workflow and the full picture as it relates to payer responses and activity," AppRev said in a prepared statement.

Medical Group Management Association (MGMA) noted "clean" claims typically meet the following criteria:

  • The claim was never rejected.
  • The claim did not have a preventable denial.
  • The claim was not filed more than once.
  • The claim had no errors.

In addition, MGMA said healthcare providers risk not getting paid with every claim rejection or denial they encounter.

According to AppRev, Denials Intelligence could help hospitals and physicians aggregate and report on denials. Using both the claims submitted to payers and the corresponding remittances, Denials Intelligence collects denials data and posts the results on a healthcare provider's AppRev Web portal. AppRev claims Denials Intelligence can help healthcare providers overcome "operational challenges and inconsistent use of standardized remittance remark codes."

Bart Fiser, executive director of corporate revenue cycle at North Carolina's Cape Fear Valley Health, said Denials Intelligence could provide his organization with more denials data than has previously been possible.

"Through this newest engagement, we are expecting to bring together several divisions for significant process improvement as we will be able to report denials and trends at department levels," Fiser said in a prepared statement.

AppRev points out Denials Intelligence includes:

  • An all-payer dashboard
  • Payer scorecard
  • Rules-driven methodology

All Denials Intelligence results are available through individual and enterprise work queues, AppRev said. The company also noted its BI solutions are customizable.