Denial intake
Starts whenA denied line, a 277 or a payer letter arrives
Reads the codes, puts them in plain language, sets the deadlines and starts the right playbook.
Denial management
Every denial worked. Every dollar chased.
Nothing waits in a denial queue for someone to get to it, and nothing is written off unless your rules allow it.
- Denials routed by reason code
- Authorization denials resolved
- AI-built appeals that argue the payer's policy
AI-built appeals
Appeals that argue the payer's own policy.
worklist's AI reads every note, every medical record and every claim line, finds the policy the payer used to deny, and answers each of its criteria with the page that proves it.
- 01
Reads everything
Every progress note, order, test result, authorization, claim line and remittance on the account. Nothing is skimmed.
- 02
Finds the rule behind the denial
The payer's medical policy, LCD or NCD for that code and date, and the exact criteria it says weren't met.
- 03
Argues criterion by criterion
Each requirement answered with the document and page that prove it, and the policy's own words quoted back.
- 04
Builds the packet
The letter, the payer's form and only the records that matter, in one indexed PDF with numbered pages.
- 05
Rates its own case
Every appeal is marked strong, fair or weak. Weak ones, and any new payer or template, wait for a person's yes.
- 06
Files and follows up
Sent by the payer's channel before the deadline, tracked to a decision, and taken to the next level when it's worth it.
How it runs
From denial to recovered dollars.
- 01
Denial arrives
- 02
Read and sorted
CARC and RARC codes read, non-denials ruled out and copies of the same denial merged into one case.
- 03
Value and deadline
Amount at risk, expected recovery and the earliest deadline: corrected claim, reopening or appeal window.
- 04
Path chosen
Corrected claim, appeal, rebill another payer, request information, move to the patient or write off, by your rules.
- 05
Playbook runs
The playbook for that reason does the work, from finding an authorization to building the appeal.
- 06
Fed back upstream
Every denial records the payer, reason, code and provider, so repeat causes are found and fixed.
Every automation
What denial management includes
Each one runs on its own, inside the systems you already use, and only asks a person when your rules say so.
Authorization denials
Starts whenCO-197, CO-198 or N54
Looks for the authorization on the payer portal, asks the ordering office when it's missing, then corrects the claim or appeals.
Medical necessity appeals
Starts whenCO-50, CO-11 or CO-167
Gathers the records, answers the payer's policy point by point and builds the appeal packet.
Coding and bundling
Starts whenCO-4, CO-97, CO-236 or CO-150
Sends a corrected claim when the record supports the fix, with a coder's approval for any judgment change.
Missing information
Starts whenCO-16 with its RARC
Fills the missing data from the record or the practice and resubmits.
Coverage and wrong payer
Starts whenCO-22, CO-27 or CO-109
Finds the right coverage and payer, then rebills with the denial as proof of timely filing.
Appeals at every level
Starts whenA denial is worth contesting
Picks the payer's level and deadline, gathers the required documents, writes a letter that rebuts the denial point by point and tracks it to a decision.
Write-offs with guardrails
Starts whenA balance can't be recovered
Checks that nobody else can pay, maps the reason to your adjustment code and asks for approval above your limits.
Where your team steps in
Your denial team decides. worklist does the legwork.
Every denial is worked from the day it arrives. People step in for the calls that need judgment, with the deadline and the evidence in front of them.
- Choose the pathWhen the rules aren't sure, the options are shown with the deadline, none pre-selected.
- Approve appealsWeak or new appeals wait for a yes, with every fact tied to a document.
- Approve write-offsAbove your limits, by reason, payer and amount. Nobody answering means no write-off.
FAQ
Questions, answered
Which denials does worklist work?
All of them. Each reason has a playbook: authorization, medical necessity, coding and bundling, missing information, coverage, coordination of benefits, timely filing, duplicates and more. A code without a playbook goes to a person with a recommendation.
Will it miss an appeal deadline?
Every denial gets a send-by date from the payer's rules. If nobody has decided three days before it, worklist takes the path that protects your rights, usually the first appeal level, and records why.
Can it write money off on its own?
Only within the limits you set. Above them it asks, and when nobody answers, nothing is written off.
Does it stop repeat denials?
Every denial records the payer, reason, code and provider, so a cause that keeps coming back can become a new claim scrubbing edit.
Early access
Run your revenue cycle as workflows.
We are working with a small group of billing and operations teams to shape worklist. Tell us where your work gets stuck, and we'll show you how it would run.
Request early accessor write to [email protected]
One platform, every role