AI-powered denials management
AI denials management works claim denials end to end: it reads denial letters and 835 remits, maps CARC and RARC reason codes, creates Revenue Management Tasks, and publishes corrected claims to the clearinghouse. Your team works the exceptions that need judgment while the repetitive rework runs automatically.
Denials waste hours and delay revenue
Teams chase paperwork, rekey data across systems, and miss resubmission windows. Every denied claim is revenue sitting on the table, and the longer it takes to resolve, the less likely you are to recover it.
Flexbone ingests denial letters, extracts key data, creates structured Revenue Management Tasks, and pushes corrected claims back to clearinghouses, automatically.
Denials through root cause prevention
Cash recovery with automated resubmission
Visibility into every claim
How does AI automate the denials workflow?
Flexbone automates the denials lifecycle from ingestion to resubmission, so your team focuses on exceptions, not paperwork. Verifying coverage up front with eligibility verification prevents many of these denials from happening at all.
Ingest Denials
Automatically ingest denial letters from PDFs, faxes, ERA/835 files, and EDI channels. No manual scanning or data entry required.
AI Extraction
OCR and NLP extract payer name, claim details, denial reason codes, and required actions from unstructured documents, even handwritten notes and low-quality faxes.
Create Revenue Management Tasks
Structured RMTs are created for each denial, classified by reason code, payer, and priority. Tasks are routed to the right team member automatically.
Automate Corrections
AI identifies the correction needed (missing modifier, auth number, diagnosis code) and prepares the corrected claim for resubmission.
Publish to Clearinghouse
Corrected claims are pushed directly to your clearinghouse. Status updates sync back in real time with a full audit trail.
What can AI denials management do?
Each capability reduces manual rework and recovers revenue faster across commercial and government payers, from Medicare and Medicaid to Aetna, Cigna, and UnitedHealthcare.
OCR + NLP Document Parsing
Extract structured data from denial letters, EOBs, and remittance advices, regardless of format. Handles PDFs, faxes, scanned images, and EDI files.
Auto-Classification of Denial Reasons
AI categorizes denials by reason code, payer, and root cause, surfacing patterns that help you prevent future denials, not just fix current ones.
RMT Creation & Routing
Structured Revenue Management Tasks are created automatically and routed to the right person based on denial type, payer, and priority level.
Clearinghouse Publishing
Corrected claims are pushed directly to your clearinghouse with all required attachments and documentation. No manual rekeying.
Real-Time Dashboards & Audit Trail
Full visibility into denial volume, recovery rates, aging, and root cause trends. Every action is logged with timestamps for compliance and performance tracking.
Frequently asked questions
AI denials management uses software agents to work claim denials end to end: reading denial letters and 835 electronic remittance advice, mapping CARC and RARC reason codes, building corrected claims, and resubmitting through the clearinghouse. Flexbone routes the exceptions that need judgment to staff and handles the repetitive rework automatically.
Flexbone ingests denials from PDFs, faxes, and 835/EDI files, then uses OCR and NLP to extract the payer, claim, and denial reason. It classifies each denial by CARC/RARC code and root cause, creates a Revenue Management Task, applies the correction (a missing modifier, prior-auth number, or diagnosis code), and publishes the corrected 837 claim to the clearinghouse with a full audit trail.
The system maps standard CARC and RARC codes across commercial and government payers including Medicare, Medicaid, Aetna, Cigna, Humana, and UnitedHealthcare. It reads 835 remits and works both clinical and technical denials, escalating clinical appeals that need documentation to your team.
Yes. Flexbone connects to common revenue cycle systems such as athenahealth, eClinicalWorks, NextGen, and Epic, and publishes corrected claims through the clearinghouse you already use, including Availity. Status updates sync back into the chart so posters see recovery in real time. See how it pairs with the AI patient coordinator.
Yes. Flexbone runs under a signed BAA with encryption in transit and at rest, role-based access to PHI, and complete logging of every action the agent takes on a claim. Each correction and resubmission is recorded for audit and appeal support.
Recover revenue automatically
AI-powered denials management with intelligent appeals, root cause analysis, and prevention workflows, built for healthcare revenue cycle teams.