Problem Statement

Once a claim is appealed, the outcome sits with the payer, and the provider has no signal until someone logs into the payer portal and looks it up. Staff must check each appealed claim individually across multiple portals, which is slow, repetitive, and easy to backlog. While appeals wait unchecked, accounts age in Accounts Receivable and time-sensitive next steps get missed. A won appeal isn't posted promptly. An upheld denial or a request for additional documentation can slip past the window to escalate or respond. That turns a recoverable denial into a permanent write-off, after the organization already invested the work to appeal it.

Automation Solution

This automation checks the status of appealed claims on Availity, records the result in the EMR, and routes accounts for next action based on the appeal outcome.