Key takeaways
- An agent in H2O AI Super Agent reads the denial, gathers the supporting chart documentation and payer policy, and drafts the appeal letter with the governing clause cited.
- A model in H2O Driverless AI can rank the denial queue by the chance an appeal is paid and the amount at stake, so your team works the most valuable claims first.
- Nothing goes to a payer until your specialist approves it, and the first runs happen in shadow mode against past denials before touching a live claim.
- H2O supports HIPAA and HITECH requirements, and protected health information never has to leave your boundary.
Work the highest-value denials first
Your denial specialists read a rejection code, open the chart, hunt for the documentation that supports the claim, find the payer's policy clause and write the letter by hand. Then they track the response and do it again for the next claim.
Most teams work the queue in the order it arrived, not by what it is worth. The care was delivered and documented. What costs you is the labor of proving it, one claim at a time.