health clinicians at conference table

Denials management solution for lasting improvements

Denials management is crucial to a provider's revenue cycle management program. CGI Denials Management Services is the ideal solution for defending against revenue loss and administrative workload escalation by providing technology to ensure your denials are processed accurately and efficiently. We utilize the many benefits of artificial intelligence in the healthcare field to manage denied claims, increase billing, and implement lasting improvements.

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Healthcare claims and denials by the number

10%
of all claims are denied, on average
65%
of denied claims are not resubmitted
$65K
are written off per year on average per provider

A devoted denials management partner for public and private healthcare organizations

For over 30 years, CGI has been a trusted strategic partner to U.S. public and private health organizations. Our specialized healthcare professionals possess profound knowledge in analyzing and auditing medical claims data with proven results in recovering well over $3 billion in improper medical claims. As a global leader in payment integrity, CGI partners with clients and provides innovative ways to meet and conquer the toughest industry challenges, like healthcare denials management, with lasting game-changing solutions.

denials management services dashboard

Learn more about CGI healthcare denials management services

Audit management services

Healthcare audits can be a highly effective cost-containment solution when managed through our process. Our healthcare denials management services include DRG validation and clinical appeals, retrospective audits, auditing support diagnosis-related groups (DRG) validation, audit policy creation and management, and under-billed audits.

Effective denials management

We manage denials and control costs as a critical component of revenue cycle management. We accomplish this while improving the overall strategy and reducing the number of denied claims yearly. Our approach is non-obtrusive, not needing constant oversight from healthcare staff.
 

Compliance and security

Our healthcare denials management solution is a HIPAA/HITECH compliant Salesforce cloud-based app offering rich reporting and visibility into complex workflows. It provides a real-time view of the status of claim denials, offers drill-down visibility for the specific audit, and audit priority can be adjusted according to needs.

Managing the appeals process

Following re-submission of the adjudicated claim, if appeals are necessary, we will manage your appeal through to its final adjudication. Over 70% of appeals are won either partially or in total. We review and store win strategies in our knowledge library to share our successful techniques with your revenue cycle team.

Ready to learn more about CGI's denials management services?

Are you ready to learn how CGI's healthcare denials management services can help your private or public organization? We are excited to share how our solution defends against revenue loss and administration workload escalation through revenue cycle management program transformation.