Here's a number most practice managers don't know: 58–72% of denied claims are overturned on appeal. A Health Affairs study found initial denial rates of 17% in Medicare Advantage, with 57% ultimately reversed. For specific payers, overturn rates climb to 67–75% with proper documentation, and up to 89% with AI-powered appeal tools.
Yet most practices don't appeal. The denial gets written off, the revenue disappears, and the pattern repeats. For specialty practices where individual claims run into thousands of dollars, this compounds into six- and seven-figure annual losses.
Speed
Work denied claims within days. Automated denial detection, categorization, and routing to the right specialist. A denial sitting in queue for two weeks may have passed its appeal deadline.
Specificity
Payer-specific appeal strategies. Aetna requires citing exact Clinical Policy Bulletins. UHC requires different documentation. Generic templates don't win — payer expertise does.
Systems
Track denial patterns, identify root causes, feed insights into prevention. The practices achieving 30–40% denial reductions aren't just appealing more — they're preventing denials.
TRIARQ Health's Pathways Revenue Performance integrates denial recovery and prevention — appeal insights feed directly into pre-submission claims intelligence.
Both. Prevention reduces volume. Recovery captures value. Together, they protect the full revenue cycle. The organizations winning in 2026 build infrastructure for both and connect them with analytics and feedback loops.
When people and intelligence move together, care performs better. Costs fall. Quality rises. Trust grows.