Healthcare Solutions

Denial Management Intelligence

Revenue cycle teams spend hours manually reviewing 835 remittance files and unstructured payer correspondence to identify denial root causes. With average denial rates between 5-10% and each claim costing $8.70 to process, the compounding cost of rework, appeals, and write-offs erodes margin at scale. Payer-specific denial patterns across CPT codes and service lines remain invisible without structured analysis, leaving recovery probability unquantified and appeals deprioritized.

Built For

Revenue Cycle Director recovering $2M+ in annual claim denials across a multi-facility health system managing 500,000+ claims per year

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Lumi Care

Revenue Cycle Director

Recovers lost revenue by mining 835 remittance data for denial patterns and recovery opportunities.

Denial Pattern Mining
Payer Scorecards
Appeal Prioritization
Recovery Probability
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Lumi Watch

Compliance Auditor

Identifies coding and documentation deficiencies driving preventable denials.

Coding Audit
Documentation Gap Detection
Denial Prevention
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Lumi Ledger

CFO (Health)

Quantifies the financial impact of denial categories and tracks recovery against write-off exposure.

Denial Cost Analysis
Write-Off Exposure
Recovery ROI
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How It Works

Mine denial patterns across payers, CPT codes, and service lines. Surface root causes, prioritize appeals by recovery probability, and track payer-specific denial trends over time.

Instant Analysis

Drag and drop your CSVs. No complex pipelines required.

Natural Language

Ask questions in plain English, get instant answers.

Lumina Analyst
Which payer and CPT combinations are driving our denials, and which appeals should we work first?

UnitedHealthcare CARC-50 medical-necessity denials on CPT 99214 jumped 38% this month and now account for $312K in held revenue, with an estimated 71% appeal-recovery probability. Recommend routing those to the appeals queue first; they carry the highest recoverable dollars per analyst hour and clear well within the 90-day filing window.

Denied Charges by Payer and CARC Code
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