Revenue
Fewer denials.
Faster appeals.
CIVIE checks eligibility, authorization and coding against the record before the claim leaves. Denials that still come back are found, explained and appealed, with no automatic write-offs.
Denial work queue · traced to cause
4 openIllustrative
The challenge
Most denials start
at the front desk.
Caused upstream. Inactive coverage, a missing authorization or a documentation gap starts at scheduling or in the report, weeks before the denial arrives.
Appeals take too long. Staff pull records, check payer policy and write letters by hand, so many appealable denials are never worked.
Written off quietly. Small denials age out or are written off, and nobody sees the pattern behind them.
Manual against CIVIE
Worked after the fact,
or stopped before it.
Manual
- Inactive coverage or a missing authorization is found when the denial arrives
- Staff pull records, check payer policy and write appeal letters by hand
- Many appealable denials are never worked
- Small denials age out or are written off quietly
- Nobody sees the pattern behind them
With CIVIE
- Eligibility, authorization windows and diagnosis checked against the report before submission
- The appeals agent retrieves the records, validates them against payer policy and submits the package
- Agents watch claim status and detect denials and underpayments as they arrive
- Nothing is written off without a rule you set or a person deciding
- Each denial reason points at the step that caused it, from scheduling to coding
How CIVIE helps
Stop them early.
Win them back.
Claim #88213 · CT abd/pelvis w/ contrast
AI validation- Eligibility verified · UHC PPO
- Diagnosis matches the signed report
- Contrast captured · Q9967 × 100 mL
- Prior auth window ends before date of service
Denial work queue
12 openChecked before submission
An AI claim validator checks eligibility, authorization windows, diagnosis against the report and payer edits, with historical approval insight.
Learn more about Checked before submissionDenials found and explained
Agents watch claim status, detect denials and underpayments and identify the root cause and next action.
Learn more about Denials found and explainedAppeals built with the evidence
The appeals agent retrieves the records, validates them against payer policy and submits the appeal package.
Fixed where they started
Because the claim links back to the order, each denial reason points at the step that caused it, from scheduling to coding.
Bulk work by plan and reason
Custom queues and rules work denials in bulk by payer, location or reason, and learn from each adjudication.
No automatic write-offs
Nothing is written off without a rule you set or a person deciding.
Revenue results
Paid the first
time.
- 98.7%of claims paid on first submission
Results across CIVIE RCM clients.
FAQ
Questions,
answered.
Eligibility and coordination of benefits, medical necessity, prior authorization, credentialing, timely filing and coding denials, with anything unusual routed to your team.
Next steps
Stop denials
where they start.
Bring a month of your denials and see how CIVIE would work them.