Denials Archives - Page 2 of 3 - Sift Healthcare
How to Know if a Denial Cluster is Worth Automating with an AI Agent
Agentic AI is being hailed across the revenue cycle right now, for appeals, claim resubmissions, documentation retrieval and a slew of other workflows. For the most part, the use cases make sense on paper. But many health system revenue cycle teams are making deployment decisions based on...
CEO Perspectives: Health Systems Are Wrong About Their Denial Rates
I don’t mean that to be provocative, I mean it literally. The number any given hospital revenue cycle team reports as its denial rate is almost certainly not its denial rate. Upstream Revenue Loss Most health systems measure denials through...
Score First, Outsource Second: Why A/R Scoring is the Smarter Path to RCM Vendor ROI
Dollar value and recovery probability are not the same thing. Health systems that outsource without scoring first are paying contingency fees on claims they could have kept. For most health systems, accounts receivable outsourcing feels like a necessary hedge against...
Segment Loop 2110: Another Way Your 835 Isn’t Showing Your Denials
The Loop 2110 segment was designed to communicate payer decisions. But payers have moved on, and health systems still managing denials through the remittance file are working with an incomplete picture. We’ve seen an influx of Google searches for “835...
Aetna’s SOI policy is changing inpatient reimbursement without showing up as a denial.
Last week, we wrote about PLBs and how revenue is being pulled back after payment in ways most teams aren’t actively monitoring. We’re also seeing a similar dynamic show up earlier in the process. Aetna’s SOI-based inpatient policy approves stays...
Your Denials Team Is Under-Informed…
Day-in and day-out most denials teams are making high-stakes decisions with low-grade information.
Sift’s Fourth Annual Denials Insights Report
Sift Healthcare's Fourth Annual Denials Insights Report analyzes 2025 payer behavior trends and how they are reshaping the way health systems measure reimbursement risk.
Beyond Denials Management – Adverse Payment Outcomes
Revenue cycle teams spend enormous energy managing denials, yet health systems still lose revenue. Here’s the case for a broader approach.
An Expanded Partnership With Hartford HealthCare
Sift Healthcare’s expanded partnership with Hartford HealthCare reflects a shared conviction that healthcare’s denial problem is the result of a clinical-financial intelligence problem.
Solving Revenue Cycle Bottlenecks with AI Copilots
AI copilots enhance CDI by connecting clinical and financial data, improving claim accuracy, reducing denials, and optimizing automation in revenue cycle management.