DataRovers Denials 360 is an AI-powered, end-to-end denial management solution designed specifically for healthcare organizations, including RCM companies, hospitals, and solo/group practices. The platform leverages advanced machine learning (ML) and generative AI (Gen AI) technologies to automate and optimize the entire revenue cycle management (RCM) process, from claim triage to final appeals.
Key Features and Capabilities
- AI-Powered Smart Queues for Triage: Automatically prioritizes claims based on financial impact, urgency, and denial reason codes, ensuring RCM teams focus on high-value claims first to maximize revenue recovery and reduce backlogs.
- Predictive Claim Scoring: Utilizes proprietary ML models to forecast claim approvals, flag potential underpayments, and identify high-risk claims for proactive intervention before submission.
- Generative AI-Powered Data Visualizations: Provides instant, clear, and actionable insights through AI-generated dashboards and visual reports, empowering teams to make faster, data-driven decisions.
- Root Cause Analysis & Denial Prevention: Analyzes denial patterns and root causes to implement targeted prevention strategies, including automated error-checking for medical necessity, DRG, and coding errors pre-submission.
- Automated & Simplified Appeal Management (Smart Appeals): Streamlines the appeals process with Gen AI-powered automation, including built-in support for generating precise appeal letters for medical necessity and DRG-based denials.
- Real-Time Compliance Checks & Policy Updates: Continuously updates payer rules and coding standards to ensure claims compliance and prevent denials due to outdated or incorrect information.
- Intelligent Workflow Management: Provides a unified work management system with smart reminders and alerts to boost team productivity and ensure no follow-up task is missed.
Target Users and Value
DataRovers Denials 360 is designed for Revenue Cycle Management (RCM) teams, billing professionals, and healthcare administrators. The primary value proposition is shifting the RCM process from a reactive state (appealing denials) to a proactive one (preventing denials), which can lead to a significant increase in revenue recovery and a smoother RCM process.
