How does the platform turn claim denials into a managed pipeline?
HFMA benchmarks place SNF first-pass denial overturn rates at 55–65% for well-run revenue-cycle teams; smaller operators using email and spreadsheets often sit at 35–45%. Denials get printed, dropped in a folder, and worked when someone has time. By the time a denied claim is reworked, the filing deadline is approaching and the documentation trail is cold.
Detail
Every denial is captured at posting with reason code (CARC/RARC), payer, amount, and aging. A denial worklist routes by reason — clinical denials to the MDS coordinator, eligibility denials to admissions, coding denials to HIM. Each denial carries a timer against the payer\u2019s rework deadline. Root-cause categorization drives upstream fixes so the same denial does not recur.
Pilot communities lift overturn rates from a baseline of 35–45% to 60–70%, and recurring denial categories drop quarter over quarter as upstream causes are fixed.
Key points
- Waystar',
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- eSolutions
https://seniorcre.com/workflows/financial/denial-management