Does your day start with the most dreaded part of your EHR inbox: denials?
You wake up each day ready to focus on patient care, not to face a mountain of rejected claims, cryptic payer messages, and looming resubmission deadlines. And yet, this is the reality for many.
You didn’t go into medical school to battle insurance red tape or rewrite the same appeal letter a dozen times.
Industry data confirms what providers already know: claim denials are on the rise and getting complex. Interestingly, AI is now at the center of controversy, with providers raising concerns that payers are using AI algorithms to auto-deny claims, sometimes without proper clinical review.
There’s no denying that AI holds tremendous potential to transform the healthcare industry. But when it’s being used against you rather than for you, it can feel less like a breakthrough and more like a barrier.
So, how do you turn the tide?
To win the denial war, you need to harness the same AI force, not as your adversary, but as your ally. It’s time to fight AI-driven denials with AI-powered defenses.
Claim denials have quietly escalated into one of the most costly and disruptive challenges in the healthcare industry. Kodiak Solutions’ 2025 benchmarking report sheds light on the rising complexity and frequency of claim denials. The initial denial rate in 2024 rose by 2.4%, reaching 11.81%. A closer look reveals the spike is tied to an increase in payer requests for information (up 5.4%) and growing pushback on medical necessity (up 5%).
The ripple effects extend further. Cash flow delays due to increasing accounts receivable (A/R) days are becoming the new norm. In 2024, A/R days increased by 5.2% to 56.9 days, up from 54.1 days the previous year, indicating a widespread slowdown in payments. Patient collections have also declined as rising healthcare costs make it harder for individuals to pay out of pocket. For commercially insured patients, collection rates dropped about 8%, to 34.5%, widening the revenue gap for providers already under pressure.
Providers are voicing concerns that the unregulated use of AI by payers is a key driver behind the spike in denials. Nearly 6 in 10 say they’re concerned that AI is fueling more prior authorization denials.
As payers adopt AI to manage mounting volumes of requests and improve operational efficiency, the downstream effect is a surge in automated denials. What once required a trained reviewer for clinical judgment now rests in the hands of systems optimized to detect technical deviations. As a result, providers are grappling with loss of valuable time and shrinking revenue, while patient care gets caught in the crossfire of algorithms that lack context and compassion.
Unfortunately, despite the growing complexity of claim denials, nearly half of providers still rely on manual processes, with only 10% embracing AI-driven solutions. In a battle dominated by artificial intelligence, trusting outdated methods puts you at a disadvantage. It’s time to reinforce your battalion with AI, the most potent weapon in your arsenal.
You can’t win today’s battles with yesterday’s weapons. Modern problems require modern solutions. So why fight algorithmic denials with outdated processes? It's time to empower your team with AI.
But, don’t just play defense; deploy a proactive approach that eliminates denials before they even arise. Let's discuss how you can leverage AI to prevent and manage denials.
2024 brought a welcome dip in prior authorization denials, but the battle is far from over. Prior authorization requirements continue to rise, particularly among Medicare Advantage enrollees, where approvals are now mandatory for some expensive services. Even more concerning is that nearly 8 in 10 prior authorization requests lead to treatment abandonment, delayed care, and jeopardize clinical outcomes. Even a seemingly minor oversight during verification can trigger a chain of avoidable denials, administrative backlogs, and disrupted care plans.
AI-driven tools are now changing that. These systems stay up to date with constantly shifting payer rules and flag authorization requirements in real time, before care is delivered. They automatically identify services that require approval, generate and submit requests with supporting clinical documentation, and track status updates.
AI dramatically reduces missed authorizations, one of the most preventable causes of denials, eliminating potential roadblocks early. As a result, you experience fewer delays, less administrative burden, and greater compliance across the board.
Clean claims are the fastest route to reimbursement. Ideally, practices aim for a clean claim rate of 95% or higher. But getting there depends on one critical step: effective claim scrubbing.
Manual claim scrubbing is slow, labor-intensive, and error-prone. Traditional rule-based systems detect common coding errors but struggle with real-time changes to payer guidelines or nuanced coding logic. Moreover, they require constant manual updating.
AI eliminates these outdated roadblocks. These advanced scrubbing tools scan claims with remarkable accuracy and speed, identifying issues such as missing information, incorrect modifiers, mismatched or obsolete codes (ICD-10, CPT, HCPCS), and formatting errors specific to each payer that often slip through the cracks. This preemptive quality check drastically reduces initial denial rates and saves time on rework.
Not all denials carry the same weight. Some are easy wins, while others turn into long, draining battles with little chance of success. When managing high denial volumes, prioritization matters.
AI cuts through the clutter by analyzing denial patterns, payer behavior, and historical appeal outcomes to identify claims that are most likely to be overturned and those that carry the highest financial return. It automatically prioritizes high-value, high-success appeals, optimizing ROI and reducing administrative burden.
It's normal to make mistakes, but repeating the same ones over and over? That drags down your productivity and revenue. If submitting insurance claims feels more like crossing your fingers than following a process, something needs to change. Predictive claim analysis brings that change.
AI can predict denial risk by analyzing denials and payer behavior. It gives your billing team a head start by reviewing claims for documentation accuracy, proper code and modifier use, compliance with payer guidelines, and patterns in payer behavior. If it identifies a potential issue, it flags the claim and notifies your team. This early alert enables you to rectify the error before sending out clean claims.
Claim denials have surged, but what's concerning is that providers appeal less than 1% of the denied claims.
For most practices, it’s not about willingness. It’s about time. Amid the growing staff shortage, teams are already stretched thin, and dealing with denial letters, collecting support documentation, and drafting appeals often feels like climbing a mountain with no clear path. Moreover, many rely on outdated templates or manual processes that rarely succeed, making the effort feel pointless.
Unfortunately, every unappealed denial is lost revenue that your practice rightfully earned. Never leave it behind; fight for what's yours. Let technology do the heavy lifting.
AI identifies winning appeal strategies by analyzing past outcomes, payer responses, and effective language. It can automatically draft compelling appeal letters and highlight the necessary supporting documents, empowering your team to submit appeals effortlessly and recover lost revenue.
At Glenwood Systems, we believe that a successful appeal process is more than resubmitting a claim; it’s about having a focused, strategic approach to denial resolution. With our advanced practice management tools and data-driven insights, we help you identify denial reasons, streamline appeal workflows, and recover the revenue you deserve.
Denial management can feel like a never-ending game of whack-a-mole. When you think you've resolved one issue, another denial surfaces; another code, another payer, same frustration. It’s exhausting, time-consuming, and keeps your team trapped in a constant cycle of reaction instead of resolution. It’s time to break that loop.
AI helps shift your approach from reactive to proactive. It learns from past denial trends, aligns each claim with the latest payer rules, and detects common triggers that often lead to rejections, fine-tuning your workflow along the way. They flag high-risk claims before submission, ensuring your team can validate their accuracy before it's too late.
AI also gets smarter with every denial. Its machine learning capabilities help refine appeal letters by analyzing past rejections and payer responses, increasing your chances of overturning denials.
Every denied claim is money your practice has already earned, but hasn’t been paid. With rising denials and shrinking margins, it's no longer viable to accept losses as part of doing business. AI gives you the tools to fight smarter, not harder. Equipped with the right tech, you can regain control of your revenue cycle.
Glenwood Systems promises a 95% first-pass acceptance rate, aims to pay 96% of claims within 30 days, and targets a 99% collection rate on payer claims. Powered by advanced practice management solutions (GlaceEMR and GlaceRCM), we help private practices optimize workflows, reduce denials, and accelerate revenue collection with unmatched efficiency.
Your work deserves full payment. Let's reclaim what's rightfully yours.
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