Solutions · Denial Fightback
Stop denials at the source. Win the rest on appeal.
Adentris finds the denial root cause, assembles the supporting documentation, drafts the appeal with the regulatory citation, and tracks every dollar. Working a $120 denial is now profitable.
app.adentris.com / denials / worklist LIVE
Denial worklist · ranked by expected value $106K recoverable
CO-197 · Sentara · H2011 crisis "no auth"
Auth-exempt per policy 4.07b · appeal letter drafted · 3 notes attached
Appeal drafted Policy cited Evidence: 3 docs
CO-B7 · Cardinal Care · enrollment gap
Root cause: provider effective date · routed to credentialing
CO-97 · Aetna · NCCI bundling
Modifier 25 clinically supported · corrected claim queued
root cause fixed upstream for 3 patternswin rate 74%
−62% First-pass denial rate, 90 days, multi-site behavioral health customer.
The problem
Denied claims are written off because the math says don't fight.
How it works
From denial receipt to payer response, automated.
Denial received
Adentris reads the 835/EDI feed and the billing-system queue. Every denial is captured, regardless of dollar value or payer.
Root-cause clustering
Denials are clustered by root cause and payer pattern. Authorization mismatch, missing modifier, NCCI bundle, parity-eligible BH, late submission. Patterns surface for the documentation team to fix at source.
Cited appeal generated
Appeal letter drafted with the specific federal/state statute the payer violated, supporting chart documentation attached, payer-format-compliant. Reviewer approves and submits.
Track to recovery
Pipeline view: appealed, awaiting response, escalated, won, lost. Payer-pattern dashboards. Win-rate by payer, by denial reason, by appeal author.
What you get
Customer-validated outcomes inside 90 days.
Adentris fundamentally changed how we approach documentation quality and compliance oversight. Instead of discovering problems weeks later during audits or payer reviews, our team can identify and address issues proactively as part of everyday operations. I can't imagine going back to the old way.
Rebecca Legov
COO, Resilient Recovery Treatment
Side by side
Adentris vs the alternatives.
Capability
Adentris
Manual appeals
Other appeals tools
Dollar threshold worked
$0, every denial worked
$200–$500+
$100–$300, queue-based
Appeal drafting
Cited per statute, chart-attached, payer-format compliant
Generic templates + manual
Template + reviewer
Root-cause analysis
Clustered by root cause + payer pattern, fed back to docs/coding teams
Spreadsheet review
Reason-code grouping
Behavioral health parity
MHPAEA + state-parity statute library, auto-cited
Manual citation
Limited
Source platform
Same platform as chart review, coding, and prior auth
Email + spreadsheet
Standalone appeals tool
01 Does this only handle commercial denials?
All payer categories: commercial, Medicare, Medicaid, Medicare Advantage, behavioral health carve-outs. Each payer's appeal pathway is encoded with timelines, format requirements, and the documentation each line of denial typically needs to overturn.
02 What dollar threshold should we work?
Many networks ignore denials under $200–$500 because the labor cost outweighs the recovery. Adentris reverses that: the appeal letter generation is automated, so working a $120 denial is now profitable. Customers typically expand their working threshold to $0 within 60 days.
03 Can it cite parity laws and state-specific rules?
Yes. State and federal mental-health-parity statutes (MHPAEA), state-specific behavioral health coverage mandates, and Medicare LCDs/NCDs are all in the citation library. Adentris drafts the appeal with the specific statute the payer violated, not generic language.
04 What about the audit trail?
Every denial received, every root-cause assignment, every letter draft, every reviewer edit, and every payer response is logged with timestamps. Pull a complete appeal history for any claim, any payer, any time window, ready for surveyors or for negotiating contract terms.
05 Does it integrate with our billing system?
Yes. Adentris reads denials from the 835/EDI feed and the billing system's queue. Writes appeals back via portal, fax, or letter as the payer requires. The AI Web Agent handles the systems that don't expose useful APIs.
06 How is this priced?
Scoped to your organization: monthly denial volume, payer mix, and which modules you turn on. Agreements are annual, with monthly payment available, and pricing is quoted after a short conversation rather than published as a list. The rapid audit pilot clusters your real denials and projects what is recoverable before you commit to anything. See plans by organization size →
See Denial Fightback on your unworked denials.
Book a live walkthrough on your real payer mix, or ship us 60–90 days of denied claims and we'll cluster the root causes, project recoverable revenue, and draft sample appeals on your top denials.