The Assessment Doesn't End. It Becomes Your Operating System.
After the 4 to 6 week assessment, the Live Platform activates. Structured intake keeps flowing. Recommendations re-run on each new data cut. A monthly committee scorecard generates itself. Autonomous agents keep discovery, implementation, and engagement health on schedule. Governance is built in.
One Continuum, Not Two Engagements
Legacy tools show you data. Consulting firms give you a report. DenialsDX gives you both, and then keeps going. The platform is the assessment, running live.
Assessment Output
Structured findings, deep recommendations, prioritized roadmap, governance charter, appeal template library, and executive readout, delivered across weeks 4 to 6.
Platform Activation
At handoff the Live Platform goes on. Recurring data cuts run through the engine. Cadence is set. Agents start work. Execution is tracked from day one.
Sustained Recovery
As your team executes, the platform surfaces what's working, what's slipping, and what to prioritize next, every week, automatically.
Structured 8-Stream Intake
Denial data alone is not enough for a CFO-grade recommendation. The intake package captures eight synchronized streams that the engine needs to size opportunities defensibly: denials, avoidable write-offs, volumes and denominators, authorization and UR events, appeals and recovery, client-specific code mappings, organizational artifacts, and client-performed root cause samples. A router auto-detects each file; a validator flags referential integrity issues before analysis runs.
- Eight templates, one guided intake page, auto-routing by header shape
- Dynamic data request package that tells you what's missing and what it unlocks
- Client code mapping sheet: your adjustment codes, CARC buckets, payer aliases, in your language
- Organizational artifacts intake: policies, org charts, workflow maps, job descriptions
- Root cause account samples from your team feed back into the engine as signal
- 835 remittance files and legacy single-file submissions still accepted
Intake Status
8 streams required for Phase 1 findings. Router detected 6 of 8.
Phased Recommendations Engine
Recommendations aren't generated from a one-time data dump. The engine runs in phases: Phase 1 findings with context gaps, Phase 2 client validation, Phase 3 structured discovery, and Phase 4 deep recommendations once your organizational context is captured. Findings are not recommendations; the distinction is preserved so depth is earned, not assumed.
- Three-tier CARC rule system spanning 308 codes and the full X12 RARC registry
- Seven enrichment layers: CMS coverage, payer intelligence, MA clinical criteria, regulatory risk, coding edits, facility-type guidance, RARC-specific appeal strategy
- Root cause inference with competing hypotheses and confidence weights
- Composite opportunity scoring across financial impact, preventability, feasibility, and recurrence
- Workstream synthesis: 30 to 50 findings grouped into 8 actionable workstreams, not a laundry list
- Each deep recommendation carries owner, timeline, success criteria, and appeal template references
| Priority | Finding | Recovery | Status |
|---|---|---|---|
| High | Prior Authorization Gap CARC 197 · Authorization Integrity |
$120K to $185K | Confirmed |
| High | Eligibility Verification Timing CARC 27 · Patient Access |
$65K to $92K | Confirmed |
| Medium | Medical Necessity, MA Plans CARC 50 · RARC N115 |
$78K to $110K | Needs Review |
AI Copilot, Grounded in Your Data
A conversational assistant built into the platform that reads your denial records, payer mix, recommendation status, and organizational context. Ask it to explain a denial trend, draft an appeal strategy against a specific payer, summarize progress on a workstream, or flag what needs attention this week. Write actions the copilot proposes are gated behind an explicit approval, so the audit trail stays clean.
- Grounded in your denial data and the 26 payer profiles in the knowledge base
- Surfaces findings, recommendations, and KPI trends conversationally
- Drafts payer-specific appeal strategies against CARC and RARC context
- Summarizes implementation progress and flags at-risk items
- Write actions require explicit approval, every change is logged
Ask anything about your denials
The Copilot has access to your denial records, KPI trends, active recommendations, and action items.
Denial Trends
What are the key denial trends over the last 8 weeks?
Recovery Priority
Which workstreams have the highest recovery opportunity?
Appeal Drafting
Draft a peer-to-peer strategy for UHC CARC 50, RARC N115.
Implementation Risk
Which recommendations are slipping this week and why?
Structured Discovery Packages
For each validated finding, the platform generates a Discovery Package: the research kit your team needs to capture the organizational context that turns a finding into a prescriptive recommendation. Shadow guides, EMR checklists, interview guides, policy reviews. No guesswork about what to investigate or who to talk to.
- Shadow guides for observing front-line workflows
- EMR checklists for system configuration validation
- Structured interview guides tailored per finding and per role
- Policy review templates for procedure gap analysis
- Async self-service discovery option: clients invite a department lead to complete a guided session
- Discovery results flow directly into the engine as organizational context
Discovery Guides
Shadow Guide · Patient Access
Interview Guide · Case Management
Policy Review · Async Self-Service
Payer Intelligence
Go beyond denial counts by payer. The engine pairs your denial mix against 26 maintained payer profiles that capture authorization rules, timely filing windows, medical necessity patterns, appeal success rates, and contract behavior. Surfaced in the dashboard and in the Copilot so the right strategy is one question away.
- 26 maintained payer profiles, commercial, Medicare Advantage, Medicaid MCO
- Authorization, timely filing, and medical necessity pattern analysis
- Appeal success rates by payer, by CARC, and by CARC plus RARC pair
- Contract compliance indicators and anomaly detection
- Payer behavior trending over rolling windows tied to your volumes
Denial Share by Payer (Top 5)
Autonomous Engagement Agents
The platform runs a set of specialized agents that handle the work that otherwise falls off the plate between meetings. The Engagement Manager coordinates phases. The Discovery Agent runs async interviews and reviews uploaded policies. The Engagement Health Monitor produces a daily operator digest and client-facing nudges. The Implementation Coach drives weekly check-ins against each owner's cadence. The Report Agent generates a monthly executive briefing on its own schedule. Nothing autonomous writes to client-visible state without an approval step.
- Engagement Manager coordinates phased engagement across specialists
- Discovery Agent runs async interviews, reviews uploaded policies, schedules sessions
- Engagement Health Monitor flags stalled phases and drafts nudges
- Implementation Coach tracks recommendation cadence against each owner
- Monthly executive briefing generated autonomously by the Report Agent
- Write actions gated by approval. Audit trail preserved. No silent changes.
Active Agents
Each agent has a scoped prompt, dedicated tools, and a cadence.
Implementation and Progress Tracking
The most expensive part of any consulting engagement is accountability. Who owns this? Where does it stand? When does it close? The platform answers those questions continuously, without another meeting. Each recommendation has a configurable cadence; the Implementation Coach agent checks in against that cadence automatically.
- Initiative-level status tracking with owner assignment
- Configurable check-in cadence per recommendation
- Milestone and deadline management
- Escalation flags when items fall behind
- Audit trail for governance and compliance reporting
Initiatives
Closed-loop initiatives tied to validated recommendations
Reporting Cadence
Two cadences, one reporting system. A weekly digest email keeps operators on pace: denial rate delta against HFMA benchmarks, preventable count, new and completed recommendations, and the three findings that need attention this week. A monthly denial committee scorecard sits on top: a methodology-bound KPI grid generated as PDF and XLSX, committee-ready. Missing data shows up explicitly as degraded or unavailable with a reason, not a placeholder chart.
- Weekly intelligence digest delivered every Monday, recipient-controlled via user preferences
- Monthly committee scorecard auto-generated as PDF plus XLSX, ready for the committee packet
- Methodology-bound KPI engine, each metric tied to a published definition
- Initial denial rate, final denial rate, net denial write-off rate, authorization denial rate, appeal overturn rate, and more
- Avoidable write-off analytics tied to HFMA MAP C-2.2
- Missing data is flagged, not hidden. No false confidence.
March 2026 Committee Scorecard
Auto-generated April 3. Weekly digest sent Mondays 9:00 UTC to subscribed recipients.
KPI Grid
Governance Toolkit
Denial improvement programs fail when accountability fades. The governance toolkit structures oversight so the work compounds over time, not just for the first quarter after the assessment. Charter, RACI, operating procedures, meeting templates, and a document workspace that keeps policies, org charts, and workflow maps in one place.
- Denial committee charter, agenda, and meeting templates
- RACI matrix for denial management stakeholders
- Standard operating procedures generated from your denial patterns
- Document workspace with client-side uploads and version tracking
- Board-ready summary report from the monthly scorecard
Available Documents
Generate governance documents tailored to your organization's data and priorities.
Formal charter for your denial management committee
Standard agenda template for denial management meetings
RACI matrix for denial management stakeholders
Standard operating procedures for denial workflows