Identify Reimbursement Risk Before Claim Submission

By the time most denials are identified, the patient is discharged and the opportunity to fix documentation is gone.
RevProtect shifts your teams from reactive recovery to proactive prevention.

Download Our Predictions Whitepaper

Predict Adverse Payment Outcomes Before Claims are Submitted

RevProtect predicts the likelihood of adverse payment outcomes at the case level, modeling reimbursement risk as clinical documentation evolves—not after a claim is denied.

By continuously aggregating clinical, 837, and 835 data, RevProtect analyzes both the adequacy of clinical evidence and the probability of triggering payer-specific business rules. This highlights which cases are at risk, why they’re at risk, and where intervention will matter most.

The Revenue Risks RevProtect Identifies

RevProtect reveals reimbursement risk across multiple adverse payment outcomes.

Administrative denials

CARC and RARC denials related to medical necessity and eligibility-driven rejections

Level of care risk

Probability of level-of-care downgrades based on documentation, utilization patterns, and payer behavior

Clinical validation and DRG denials

Risk of DRG downgrades and clinical validation denials tied to payer-specific evidentiary thresholds

These predictions update continuously as documentation, coding, and utilization data change. Teams can intervene while outcomes are still influenceable.

Payer-specific Reimbursement Intelligence

RevProtect learns and models the unique adjudication behavior of individual payers.

Instead of applying generic rules or static denial logic, RevProtect analyzes historical denial, downgrade, and payment outcomes. This enables RevProtect to identify specific documentation requirements, thresholds, and business rules required by each payer.

This payer-specific intelligence distinguishes between:

• Documentation that is clinically sufficient but payer-insufficient
• DRGs that are defensible with one payer but high risk with another
• Cases where additional evidence will materially change the outcome

RevProtect learns these payer-specific patterns over time and applies them at the individual claim level so teams understand what’s missing and what matters for the payer who will adjudicate the claim

Same case, different payer expectations

For a pneumonia with pleurisy case (DRG 193-195):

Payer A

May approve DRG 193-195 with standard documentation: Chest X-ray with infiltrate, including location and pattern, clinical features supporting diagnosis, and auscultation findings.

Payer B

Requires additional pleurisy-specific documentation: Evidence of pleuritic chest pain, pleural rub on auscultation, documentation of pleural effusion characteristics (reactive vs. parapneumonic).

Payer C

Demands comprehensive treatment response validation, which includes all requirements from Payers A and B plus: Defervescence timeline, clinical improvement markers, transition to oral medications and resolution of leukocytosis.

From Prediction to Action

RevProtect’s payer insights inform and improve RevProtect’s actionable recommendations, guiding documentation improvement, utilization review, coding decisions, and appeal strategies.

This connection between prediction and action helps health systems reduce avoidable denials, protect case mix index, and improve clean claim rates across diverse payer portfolios.

See how RevProtect turns prediction into action

Aligned to Outcomes, Not Promises

RevProtect is available through a performance-based engagement model designed to align incentives and reduce risk. Sift partners directly with health systems to tie success to measured reductions in denials and adverse payment outcomes (not activity, licenses, or usage).

Explore a performance-based engagement

Justin Nicols

Founder & CEO

A leading industry expert in data analytics technology and has an extensive background in corporate finance and investment banking. Prior to founding Sift, Justin served on the executive team of venture-backed ad technology company, and an e-commerce technology company.