1. Flag modifier, POS, and timing conflicts before submission
CARC 97 often results when services are bundled incorrectly or billed with conflicting modifiers. Set up automated flagging before the claim leaves your hands.
2. Auto-enrich missing documentation for risk-driving diagnoses
CARC 16 denials frequently occur because the diagnosis isn’t supported. Auto-populate evidence windows with MEAT proof or block submission when it’s missing.
3. Learn from 835s and fix the root cause
Denial prevention is a feedback loop. Feed historical 835s back into drafting so the same error never repeats.
4. Draft clean claims without manual rework
Every manual touchpoint adds risk. Replace hand-built templates with dynamic claim line generators that bake in payer logic.
5. Provide visibility and accountability across the workflow
Denied claims stem from ownership gaps. Introduce calm worklists with SLA tracking so risky lines are corrected before submission.
The payoff: clean claims, fewer callbacks, faster cash
By focusing on the highest-leverage denial types, hospitals solve 60% of denial volume with a handful of changes — and keep staff focused on patient care.
Ready to see it in action?
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