Reduced Claim Denials by 62% for Regional Hospital Network

MedVista Health Systems, a regional hospital network spanning 14 facilities, was experiencing a staggering 38% claim denial rate — nearly double the industry average. This resulted in over $6.8M in delayed or lost revenue annually. Their internal team lacked the bandwidth and specialized tools to address root causes, leading to a growing backlog of unresolved denials and mounting frustration among staff.

We deployed a dedicated denial management team alongside our proprietary analytics platform to categorize and prioritize denials by root cause, payer, and dollar value. Our approach included implementing automated eligibility verification at the point of registration, redesigning charge capture workflows to reduce coding errors by 74%, building real-time dashboards for leadership visibility into denial trends, and establishing a rapid resubmission protocol that cut turnaround from 45 days to just 12 days.

Within 8 months, MedVista saw their denial rate drop from 38% to 14.4% — a 62% reduction. The recovered revenue totaled $4.2M in the first year alone, and processing times were cut by 45%. Staff morale improved significantly as manual rework decreased, allowing the team to focus on higher-value tasks.