Denials Management Built to Recover Cash

Clinical expertise and AI to close denials to cash. Revecore combines denial management, clinical appeals, and receivables recovery to maximize overturn rates and ensure denied claims become collected revenue.

Clinical Expertise, Denial-to-Cash Execution, and AI Working for You

Payers are deploying AI to deny claims faster, at greater scale, and with increasing clinical complexity. Hospitals that can't match that sophistication — and close the loop from overturn to cash — are absorbing losses they shouldn't be. Revecore closes that loop, managing denials as a full lifecycle, from day-one intake and AI-assisted appeals through receivables follow-up and final cash reconciliation.

From Intake Through Final Resolution — Nothing Stalls

Revecore manages denials as a closed-loop lifecycle — integrating denial resolution, receivables recovery, and prevention — to ensure complex denials are not only overturned, but fully liquidated and less likely to recur.

Automated Intake & Categorization

Every denial is captured, categorized by type and payer, and automatically prioritized based on balance, aging, and recovery potential — ensuring denials are matched to the right experts from day one.

AI-Assisted Appeal Development

Payer-specific appeal templates, structured clinical arguments, and AI-assisted medical record summarization and appeal drafting — reviewed and validated by a Clinical Nurse Manager before submission. Every appeal reflects the nuances of the individual case.

Resolution & Receivables Recovery

Revecore resolves complex denials end to end — from clinical appeal through receivables follow-up, escalation, and reconciliation — ensuring overturned denials convert into cash, not stalled A/R or write-offs.

Legal Appeals

Revecore's Legal Appeals team brings attorney-level expertise to your most complex denials, navigating internal and external appeal pathways with thorough, compliant follow-through—all included within your standard contingency rate.

Denials Prevention

Revecore analyzes denial activity across payers, denial types, and clinical scenarios to surface meaningful patterns behind denial volume, overturn rates, and downstream leakage — enabling hospitals to address systemic issues and strengthen long-term revenue integrity.

Every Denial Type, Every Payer Class

Clinical and Medical Necessity Denials
Technical & Administrative Denials
Authorization Denials
DRG Downgrades
Audit Defense and Post-Payment Audits
Aged and Legacy Denial Recovery
Overflow and Day-One Denials

Built for the Hardest Denials

Clinician-Led Model

RNs, coders, and attorneys aligned to denial complexity — not claim volume. Every appeal is clinically validated before submission.
AI-Accelerated Appeals

AI-assisted drafting cuts appeal preparation time by 50%+ — with full clinical validation before submission.
Full Denial-to-Cash Ownership

Full lifecycle ownership through receivables follow-up, escalation, cash posting, and reconciliation — not just appeal submission.
Prevention Feedback Loop

Root-cause analytics and account-level case studies reduce repeat denials over time.

Case Study: A Southern Health System

Challenge

A large, multi-hospital health system across the South had a growing denials problem and limited access to specialized claims expertise. Revenue cycle leaders wanted a partner who could manage appeals, surface root cause, and build processes to prevent future losses — while helping staff refocus on higher-value work. They evaluated vendors carefully before committing to a direction.
Solution

The health system partnered with Revecore on inpatient denials. Root cause triage identified top leakage drivers, including a payer with a notably high denial rate — Revecore recommended a process change that reduced denials across that payer and others. They then expanded to outpatient denials and added Zero Balance Underpayment Recovery, bringing total denials recovery to $21.9 million.

Results

$21.9M recovered from denials across the partnership
Payer-specific denial rates reduced through targeted process changes
Scope expanded to outpatient denials and underpayment recovery

Proven Denial-to-Cash Performance

Up to 74%

Average success rate in overturning denials

15-30%

Reduction in denial write-offs

10-25%

Sustained reduction in repeat denials

<20

Days reduction in adjudication cycles

Frequently Asked Questions

What types of denials does Revecore handle?

Revecore manages all major denial categories — clinical and medical necessity, technical and administrative, authorization, DRG downgrades, audit defense, post-payment audits, aged and legacy denials, and overflow volume — across commercial, Medicare, Medicaid, and managed care payers in both Hospital Billing and Professional Billing environments.

How does Revecore's AI-assisted appeals process work?

Revecore’s AI identifies the evidence most likely to overturn each denial and aligns it to payer policy. A Clinical Nurse Manager validates every appeal before submission — 50%+ faster, same clinical rigor.

What happens after a denial is overturned?

Revecore's AR Management solution ensures overturned denials convert to cash — not just administrative resolution. Follow-up continues through payment receipt, cash posting, and final reconciliation. Winning is not the same as collecting — Revecore bridges that gap.

How does Revecore reduce future denials — not just recover today's?

Root-cause analytics identify what drives repeat denials. Quarterly education addresses those issues at the source. Clients see a 10–20% sustained reduction in repeat denial categories over time.

Stop Writing Off Revenue You've Already Earned.

Connect with a Revecore denials specialist to benchmark your overturn rates and identify where recovery is being lost downstream.