Leak 1: Denials

The first revenue
leak:claim denials

18.7% denial rate · 65% never reworked

Denials don’t get fixed by dashboards; they get fixed by execution. ANKA works every claim and submits every appeal. Your team doesn’t have 500–1,000 hours a month to fight denials.ANKA does.

It reads the EOB, writes and files the appeal, tracks outcomes, and reworks until resolved — with human intervention only where it matters.

57%

Of Medicare Advantage denials get overturned on appeal — yet fewer than 20% are ever appealed. The revenue exists. It’s just unworked.

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HIPAA Compliant SOC 2 Certified 4 weeks to go live

35–50%

Increase in Collections

Up to 50%

Lower Cost to Collect

Up to 60%

Reduction in 90+ Day A/R

4 Wks

Average Time to Go Live

The Numbers

The denial crisis is a capacity crisis

When volume outpaces execution, revenue gets abandoned.

$262B

Denied annually across the U.S. health system

Every year. Most of it unworked.

33%

Annual billing staff turnover rate

You can’t scale headcount to fix this.

3–6 mo

To train billing staff on new denial workflows

Before they leave and the cycle restarts.

65%

Of denials never resubmitted

That’s not a denial problem — that’s capacity.

The Process

How ANKA manages denials

Six steps. All executed. Zero abandoned claims.

Step 01

Reads the EOB

The payer sends the EOB. ANKA extracts the denial reason, claim amount, patient details, and required documentation within seconds. Your team doesn’t touch it.

Step 02

Pulls clinical documentation

ANKA searches your EHR for clinical history, operative notes, imaging reports, prior authorizations, and supporting evidence. It cross-references against payer requirements. No manual chart retrieval required.

Step 03

Writes the appeal

It generates a payer-specific appeal letter grounded in clinical evidence, aligned to the applicable medical policy and appeal format guidelines. Ready for submission in clear, factual language—not boilerplate.

Step 04

Routes for human review

Straightforward appeals move to the submission queue. Complex cases—missing documentation, unusual denials, high-dollar claims—are routed to your team. You review the 10% that require judgment.

Step 05

Submits to payer

Appeals are submitted via payer portal, EDI, or mail, depending on payer rules. Submissions are logged automatically. Timely filing deadlines are tracked. No appeals are lost in email inboxes.

Step 06

Tracks outcome and reworks

ANKA monitors appeal status. When the payer responds—paid or denied—ANKA flags it. If denied again, it reworks the appeal with a new clinical angle or additional documentation. No claim is abandoned.

FAQs

Denial Management

ANKA analyzes each denial in context: payer appeal overturn rates, claim amount, clinical strength, and your contract with that payer. If the expected recovery exceeds the appeal cost, ANKA flags it for appeal. We track your outcomes by payer and adjust the threshold over time. Some payers have 70% overturn rates on appeals (worth pursuing aggressively). Others have 15% (we are more selective). You set the minimum recovery threshold. We apply math, not guesswork.

No. ANKA reworks denied appeals. If an initial appeal failed due to missing documentation, ANKA pulls additional clinical evidence and resubmits. If the denial was based on medical policy interpretation, ANKA tries a different clinical angle. The maximum number of appeal attempts depends on payer rules—usually two to three levels—but ANKA doesn’t abandon claims. It escalates to your team when human judgment is needed. No denial goes unworked simply because the first appeal failed.

ANKA appeals are generated from your actual clinical documentation and payer contracts. They are not templates—they are specific. Payers see clinical evidence, not a form letter. Appeal acceptance rates match those of human-written appeals for routine denials. For complex denials, your team reviews before submission. We have mapped appeal requirements for 100+ payers and keep them updated as rules evolve.

For straightforward appeals (missing documentation, coding errors, medical necessity): hours. ANKA reads the denial, pulls the relevant documentation, writes the appeal, and submits it. Typical timeline: denial received to appeal submitted within 24–48 hours. Complex cases are routed to your team. No appeal sits waiting. Timely filing deadlines are treated as non-negotiable.

ANKA flags it. New denial codes, unusual payer rejections, or rare claim issues are routed directly to your team. ANKA learns from your team’s response. As ANKA sees more denial variations from your payers over time, it becomes increasingly autonomous. In the early weeks, you will see more flags. By month three, fewer. By month six, most denials are routine and ANKA handles them without routing. Your team trains the system by providing the first response to novel denials.

The Full Picture

Denial management is step one.
Here is the complete execution layer.

Underpayment recovery

ANKA checks every payment against every contract, identifies variances, and recovers what you’re owed. Contingency pricing on recovery.

Learn about underpayment recovery

AR follow-up automation

Claims age during secondary follow-up. ANKA automates status checks, resubmissions, and escalations. Nothing ages out due to workload constraints.

Learn about AR automation

How it all works together

Denial management + underpayment recovery + AR follow-up = zero revenue leakage. One platform that fixes them all. See the full architecture.

Full platform walkthrough

The first revenueleak:claim denials