What comes in
Returned claim
- Required claim field missing
- Source record has the detail
Denial ManagementIn beta
Give denied claims a next step.
Caesar turns a payer response into a denial reason and a next action. Corrections and appeal drafts reach the right queue, with the claim history attached.
- Keeps denied claims in an active queue
- Surfaces repeated payer issues
See the work
Different denial reasons need different work.
Illustrative claim follow-ups. A correction or appeal does not guarantee payment.
What comes next
Correction prepared
- Missing field completed
- Claim rechecked for resubmission
The corrected claim stays tracked after it is resubmitted.
What Denial Management does
- 1Read denial
- 2Find source
- 3Correct claim
- 4Track response
What comes in
Payment received
- Payment below expected amount
- Contract information available
What comes next
Variance review
- Difference linked to the claim
- Follow-up task prepared
The payment difference remains visible for review.
What Denial Management does
- 1Read payment
- 2Compare amount
- 3Review variance
- 4Track follow-up
What it handles
Find the reason. Work the claim.
Denial Management is part of Caesar's Revenue Cycle agent. It makes the work after the payer response visible, including payments that came back short.
Read the payer response
Review electronic remittance for denied claims and payment differences. Link the response to the original claim.
Identify the reason
Separate missing information from coding issues and denials that need clinical review.
Prepare the next action
Correct routine errors within your approved rules or prepare an appeal draft with the supporting records.
Track the follow-up
Keep resubmissions and appeals visible. Show repeated denial reasons so your team can address the source.
Fits your practice
Keep the response with the claim.
Your billing team should be able to see the reason for a denial and what has already been done about it.
- 1
Read the remittance
Match payer responses to claims in the connected billing system.
- 2
Check the cause
Use the response and claim history to identify the next action.
- 3
Review and act
Route exceptions and appeal drafts to your designated reviewers.
- 4
Follow to resolution
Record payer updates so an unresolved claim remains in view.
Recovery work stays accountable.
Your team controls correction rules and reviews cases that need judgment. Clinical appeals require clinical input. The payer determines whether a corrected claim or appeal results in payment.
- Review clinical rationale before an appeal
- Keep unresolved balances visible
Keep your existing system.
We confirm the available connections and functions in your electronic medical record system, or EMR, before setup.
Check your EMR integration
Available functions vary by system and agent.
Before you start
Your questions, answered.
What to expect from Denial Management, and what your team controls.
How is this different from the full Revenue Cycle agent?
Denial Management works claims after the payer response. It shares the Revenue Cycle platform with Prior Authorization, Coding & Billing and Payment Posting. Patterns found in denials can inform the coding checks used before the next submission.
How much denied revenue can we actually recover?
Recovery depends on the denial reason, payer mix, deadlines and supporting record. Caesar organizes eligible corrections and appeals for follow-up. Compare actual recoveries with your current denial queue during the beta rollout, since an appeal does not guarantee payment.
Does the Revenue Cycle agent prevent denials or just recover them?
It follows existing denials and uses trend analysis and payer pattern recognition to identify recurring causes. Those findings can improve upstream coding checks. Your billing team reviews changes and cases that need clinical judgment.
What about underpayments, not just outright denials?
Where contract data is available, payments are compared at the claim-line level with expected reimbursement. Underpayments stay flagged for review and follow-up instead of being silently closed as paid in full.
Which systems does it work with?
It parses EDI 835 remittance advice and uses supported clearinghouses or payer portals for resubmissions and appeals. The workflow connects with records from EHRs including Epic, athenahealth, eClinicalWorks and NextGen.
Is the Denial Management function HIPAA compliant?
Yes. The Denial Management function runs on HIPAA-compliant infrastructure. Data is encrypted in transit and at rest. Caesar Health executes a Business Associate Agreement (BAA) at contract signing. SOC 2 Type II is in progress.
How are denial reasons and corrections handled?
The agent separates coding errors and missing information from medical-necessity issues or contractual underpayments. Routine corrections, such as a modifier fix supported by the record, follow approved rules. Clinical appeal drafts require review, and resubmissions remain tracked through resolution.
What can our billing team see in the denial queue?
The dashboard links each payer response to its claim, reason and next action. It shows unresolved balances and repeat payer issues alongside the resubmission or appeal history, so aging accounts receivable remains visible.
Is Denial Management available now?
It is in beta. Your payer mix and existing denial queue determine the initial workflows, connections and review requirements.
Denial Management
See what is waiting in your denial queue.
Walk through a returned claim and how Caesar would organize the next action for your billing team.
Book a demo