Challenge: Healthcare providers are under immense pressure from labor shortages, complex payer requirements, and limited windows to respond to claim denials. A lack of real-time eligibility checks and inefficient follow-up processes often results in unnecessary denials and delayed reimbursements. Manual efforts to resolve these denials — including long wait times with insurers and fragmented documentation workflows — lead to significant financial write-offs and staff burnout.

Solution: End-to-End Denial Resolution Powered by Agentic AI: We deployed a fully autonomous Agentic AI solution that acts as a digital agent, managing the denied claims lifecycle from start to finish with minimal human intervention.

Before care is delivered, the agent performs real-time eligibility checks and reaches out to insurance payers to obtain pre-approvals, minimizing preventable denials. This proactive step alone helped reduce initial claim rejections by over 45%.

If a denial occurs, the agent takes full ownership by reaching out to patients, providers, and insurance payers via voice or chatbot to collect all necessary information. It retrieves and updates records directly in Epic EHR, equipping hospital staff with actionable information upfront — eliminating long wait times and reducing manual effort.

Impact: ·

• 70% reduction in manual follow-up time, freeing up staff for higher-value tasks.
• 50% increase in denial overturn rates, improving claim success significantly.
• >80% accuracy in eligibility checks, documentation, and payer interactions.
• Action-ready insights for hospital staff, eliminating time spent on hold or searching systems.
• $1.2M+ annual revenue recovered through timely and complete denial resubmissions.