Challenge
A large multi – specialty healthcare provider struggled with rising claim denial rates, delayed reimbursements, and high manual intervention across its revenue cycle. Disconnected systems and lack of transparency led to repeated submission errors, eligibility mismatches, and appeals bottlenecks — resulting in lost revenue and administrative burden.
Objective / Need
Reduce denial rates, accelerate reimbursements, and enable autonom ous remediation across the revenue cycle.
Solution
Novatio implemented an end – to – end process intelligence and orchestration solution that monitored RCM processes in real time — spanning eligibility checks, coding validation, claims submission, and denial management. The platform identified high – risk claims using historical denial patterns and payer behavior, while AI agents proactively corrected common errors, initiated eligibility re – verification, and orchestrated timely appeal submissions. Integration w ith EHR and payer portals ensured seamless data exchange and automated follow – ups
Outcomes
- Reduction in denial rates through proactive error detection and resolution
- 3x faster claim reprocessing with AI – powered remediation and escalation
- Improvement in Days Sales Outstanding (DSO)
- Improved payer collaboration and patient satisfaction through faster resolution
*Results described on the website are based on specific engagement and may vary depending on environment and implementation.
