Denial Fighter is one system with three ways in. Find the denials already draining your revenue, catch the next one before the claim submits, and get ahead of the code changes that create tomorrow's denials. Adopt one module for immediate ROI — or all three for a closed loop.
Denials are systemic, point-of-care, and regulatory at once — no single tool covers all three. Denial Fighter maps one module to each.
Reads your historical claims and surfaces where denials cluster — by provider, diagnosis, payer, and time — then ranks the recoverable revenue. The analytical core, built and validated as an AMIA informatics project.
An AI agent that reads the relevant payer medical policy in real time, cross-references the clinical documentation, and returns a denial-risk score with the exact gaps to fix — before the prior auth is ever submitted.
A monthly digest that monitors CMS publications and the Federal Register for billing-code changes, then explains each one's revenue impact and the action to take — so a code change never turns into a surprise denial.
The three modules aren't just adjacent — they feed each other. Findings from one sharpen the next.
The Engine shows which payers and codes deny most often → those patterns become the highest-value rules for the Pre-Check → and Code Watch feeds both a live stream of policy changes, so the rules never go stale. The result is a system that gets smarter every month instead of fighting the same denials twice.
There's no all-or-nothing. Pick the module that matches your most urgent question today; add the others as they earn their place.
Run the Engine against last year's claims to recover money already left on the table. Or subscribe to Code Watch to stop losing revenue to code changes. Either delivers value on day one, alone.
Pair the Engine with Pre-Check: the patterns you find retrospectively become the rules that stop denials prospectively. Look-back and prevent-now, working off the same knowledge base.
The full system: diagnose systemic loss, prevent it at the point of care, and stay ahead of every regulatory change — a loop that self-updates as policy shifts. One vendor, one denial strategy.
The modules exist today as independent, working pieces. The plan connects them behind a shared knowledge base — without rebuilding what already runs.
Each piece already runs on its own and proves its own value.
Connect the modules behind one source of truth so they stop duplicating work.
Move from synthetic validation to a live pilot inside a real revenue-cycle workflow.
How the prevent-now module turns a prior auth into a risk report before the claim ever leaves the building.
Provider submits the request with supporting clinical documentation via FHIR — no new data entry.
The agent pulls the relevant payer medical policy and extracts medical-necessity criteria, documentation requirements, and exclusion rules.
Returns a denial-risk score with the specific gaps, missing documents, and remediation steps — before the claim goes out.
Denial Fighter is built and validated. If you own revenue cycle, medical policy, or coding at a payer or provider, let's pilot the module that fits your most urgent question.
Denial Fighter is one of several things James has shipped. See the rest in the full gallery.