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Leak 1: Denials

The First Revenue Leak: 11.8% Denial Rate, 65% Never Reworked

ANKA executes denial management as a critical component of end-to-end revenue cycle management. Every claim gets worked. Every appeal gets submitted.

Your team doesn't have 500–1,000 hours per month to fight denials. ANKA does. We read the EOB, generate the appeal, submit it, track the outcome, and rework if denied. Human oversight for exceptions. Execution on everything else. Denial management is one pillar of ANKA's complete revenue cycle solution—alongside underpayment recovery and AR follow-up automation.

57%
Of Medicare Advantage denials get overturned on appeal. But less than 1% are ever appealed.
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ANKA AI denial management interface showing appeal generation, payer rules matching, and submission tracking
The Numbers

11.8% initial denial rate (Kodiak Solutions, 2024). 65% never resubmitted (HFMA)

It's not incompetence. It's math.

$262B
Denied annually in the U.S. health system
500–1,000
Appealable denials per month at a mid-market provider
53
Appeals one FTE can manually complete in a month (at 3 hours each)
40%
Billing staff turnover rate year-over-year
3–6
Months to train billing staff on new denial workflows
65%
Of denials never resubmitted (HFMA / Change Healthcare)

You have 500–1,000 denials a month. Your team can work 53. The gap is where revenue dies.

Medicare Advantage denials are up 59%. Your team needs a triage system — now.

We've mapped the denial surge across 40+ MA plans. What's changed. Which denials are appealing worth the effort. How to triage before your team drowns. Real data. Real playbook.

Or skip straight to numbers: Calculate Your ROI — see your exact denial backlog and recovery opportunity.

The Process

How ANKA Manages Denials

Six steps. All executed. Zero abandoned claims.

Reads the EOB

Payer sends EOB. ANKA extracts denial reason, claim amount, patient details, and required documentation. Happens in seconds. Your team doesn't touch it.

Pulls Clinical Documentation

ANKA searches your EHR for clinical history, operative notes, imaging reports, prior authorizations, and any supporting evidence. Matches against payer requirements. No manual chart pulling.

Writes the Appeal

AI generates payer-specific appeal letter. Cites clinical evidence. References the exact medical policy. Follows appeal format rules. Ready to submit. No lawyer-style language. Just clear facts.

Routes for Human Review

Straightforward appeals go to submission queue. Complex cases (missing docs, unusual denials, high-dollar claims) route to your team. You review the 10% that need judgment. Everything else submits automatically.

Submits to Payer

Appeal submitted via payer portal, EDI, or mail depending on payer rules. Submission logged automatically. Timely filing deadline tracked. No lost appeals in email inboxes.

Tracks Outcome & Reworks

AI monitors appeal status. When payer responds (paid or denied), ANKA flags it. If denied again, AI reworks with new clinical angle or documentation. Escalates to your team if needed. Claim doesn't die.

Ready to see this in action? Full walkthrough of how it works

Proof

What actually happens when denials get worked

Real outcomes from organizations like yours.

Pain Management · 250+ Practitioners

98% Denial Rate Reduction

Before: 72% of office visit denials traced to single payer (BCBS Health Select) missing auth requirement. Nobody knew. Denials just stacked up.

What Changed: ANKA's AI identified the pattern. Applied the fix to every future claim.

Result: Denial rate dropped from 72% to 2% for that payer. Collections increased 40%. One root cause. One fix. Massive outcome.

Anesthesia · 12 Providers

51% Collections Improvement

Before: 27.93% revenue leakage. Denials piling up. 2-person billing team drowning. Recurring coding errors on time-unit calculations.

What Changed: ANKA automated appeal generation and eliminated coding errors through pattern recognition.

Result: Monthly collections increased 51%. Operational efficiency up 17%. Billing team now reviews exceptions instead of writing appeals.

Ambulatory Surgery Center · 4 Locations

40% Collections Increase

Before: $82M open AR. $140M aged and written off. Denials aged out due to workload constraints.

What Changed: ANKA reworked aged denials and submitted appeals within timely filing windows.

Result: 40% collections increase in under 6 months. Cost-to-collect reduced 47%. Aging AR cleared.

Questions

Common Questions About 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're more selective). You set the minimum recovery threshold. We apply math, not guesswork.
No. ANKA reworks denied appeals. If initial appeal failed due to missing documentation, ANKA pulls additional clinical evidence and resubmits. If denial was due to medical policy interpretation, ANKA tries a different clinical angle. Maximum appeal attempts depend on payer rules (usually 2–3 levels), but ANKA doesn't abandon. It escalates to your team when human judgment is needed (unusual payer policy, contract dispute, etc.). The point: no denial goes unworked just because the first appeal failed.
ANKA appeals are generated from your actual clinical documentation and your payer contracts. They're not templates. They're specific. Payers see the clinical evidence, not a canned letter. Appeal acceptance rates mirror human-written appeals for routine denials (medical necessity, missing documentation, coding errors). For complex denials, your team reviews before submission. We've mapped 100+ payers' appeal requirements and update them when rules change. Your appeals meet spec because we built ANKA to know the specs.
For straightforward appeals (missing documentation, coding errors, medical necessity): hours. ANKA reads the denial, pulls the docs, writes the appeal, and submits it. Your team reviews if needed. Typical timeline: denial received → appeal submitted in 24–48 hours. Complex cases (missing clinical info, contract disputes, high-dollar claims) route to your team first, so they handle the judgment call. No appeal sits waiting. You're racing against timely filing deadlines, and ANKA treats that as non-negotiable.
ANKA flags it. New denial codes, unusual payer rejections, or rare claim issues route directly to your team. ANKA learns from your team's response. Over time, as ANKA sees more denial variations from your payers, it becomes more autonomous. In the early weeks, you'll see more flags. In month three, fewer. By month six, most denials are routine and ANKA handles them without routing. Your team trains the AI by providing the first response to novel denials.
The Full Picture

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

Underpayment Recovery

Payers shortpay your claims. 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 in 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. See the full architecture.

Full platform walkthrough →

Revenue Teardown

See what $1M in lost revenue looks like at a real 30-provider practice. Denials, underpayments, aged AR — dollar by dollar.

View Teardown

Your Assessment

The playbook handles triage. But if you have 500–1,000 MA denials/month, the execution gap is $200K–$750K/year.

See Your Numbers

Start Your Complimentary Assessment

We'll analyze 500–1,000 of your denied claims. Calculate exact recovery. Show you the timeline to clear the backlog.

Complimentary for qualified organizations (10+ providers).

Calculate Your ROI

5–10 business days. Typical finding: $50K–$500K in unworked recovery opportunity.