Catch revenue leakage from claim denials early
Revenue cycle teams often discover denial problems weeks after they start, losing valuable time to appeal and correct issues.
Denial Rate Alert
BlueCross PPO • Week-over-week increase
Built for finance teams
who demand accuracy
Revenue cycle teams often discover denial problems weeks after they start, losing valuable time to appeal and correct issues.
Revenue Cycle Directors overseeing end
to-end claim performance
Denial Management Specialists investigating and appealing rejected claims
Domain expertise
CFOs and VP Finance responsible for cash flow and revenue integrity
Portfolio-wide oversight
Patient Access Managers handling eligibility verification and prior authorization
Deep, consistent analysis
From alert to action in minutes
The objective of this agent is to reduce revenue leakage from preventable denials.
The Trigger
You define when the agent should activate. When conditions are met, it starts working automatically.
- Threshold alert: Denial rate for any payer exceeds 8% (or your custom threshold)
- Trend alert: Week-over-week denial increase greater than 15%
- Volume alert: Dollar value of denied claims in a single day exceeds $50,000
360° View
The agent opens a tailored dashboard consolidating data from all your systems.
- Overall denial rate compared to trailing 12-week average
- Denial rate by payer with trend indicators
- Top denial reason codes (e.g., CO-4 for authorization, CO-16 for missing information, CO-197 for prior auth)
Automated Analysis
The agent follows a structured analysis flow, combining checks with exploratory reasoning.
- Compare current denial rates to historical baselines by payer and procedure type, flagging statistically significant increases
- Categorize denials by root cause bucket: authorization/referral issues, coding/billing errors, eligibility/coverage problems, medical necessity, duplicate claims
- Cross-reference denial spikes with recent changes: new payer contracts, coding updates (ICD-10 or CPT revisions), staff turnover, system changes
Actionable Output
After analysis, the agent creates a human-friendly report with everything your team needs.
- Executive summary: Overall denial rate change, total revenue at risk, top contributing factors
- Payer-specific findings: Which payers are driving the increase and why
- Root cause breakdown: Authorization issues vs. coding errors vs. eligibility problems, with percentages
Delivery
Reports are sent automatically via email or accessed directly in Veezoo.
Key benefits for finance teams
Concrete, measurable value for your team from day one
Faster response
Before: Denial trends discovered at month-end, 3-4 weeks after issues began. Now: Alerts within days, reducing the backlog of claims approaching appeal deadlines.
Quantified priorities
Each finding includes dollar amounts, helping your team focus on the denials with the greatest revenue recovery potential.
Root cause visibility
Distinguishes between authorization gaps, coding errors, and eligibility issues so you can route problems to the right team.
Up and runningin production in weeks
To deploy this Agent, you connect Veezoo to your existing Data Warehouse, typically containing data from:
Ready to explore Denial Rate Monitor?
Fully customizable to your workflows, data sources, and business requirements.
Typical initial implementation in weeks, not months.