Healthcare organizations lose millions from preventable denials. Rivet Prevent uses AI and your successful claims to transform denial management into proactive prevention. Rather than focusing on appeals, it identifies and eliminates denial patterns before submission through x-ray mode and opportunity dashboards. Results include 20% lower denial rates, accelerated cash flow, and a shift to proactive revenue cycle management.
Across most healthcare organizations, there's a significant amount of revenue—often in the millions—caught up in preventable denials. Not only does that delay revenue or risk uncollected cash, but the rework of these denials is enormously expensive. While you may already have a workflow for managing and appealing denials, the real opportunity lies in stopping them before they happen.
Think of a claim's lifecycle in four key points:
Point A: You submit your initial claim
Point B: You receive a denial remit (835)
Point C: Your team submits a corrected claim
Point D: You receive payment on the corrected claim
The traditional denials workflow focuses on the labor-intensive process between Points B and C — identifying what went wrong and fixing it. But what if you could skip Point B entirely and go straight from submission to payment?
Rivet Prevent isn't focused on managing denials or appeals. Instead, it's built around a single goal: stopping denials from happening in the first place.
Rivet Prevent uses AI technology to compare your historical and current denials against an archive of hundreds of millions of claims and remits. Through this analysis, it identifies billing and claim submission errors and surfaces issues on an easy-to-digest dashboard, helping your team "get it right the first time."
1. Leveraging Your Successes to Prevent Future Failures
Rivet Prevent analyzes your successful denial resolutions (Point D) to determine what corrective actions (Point C) fixed the initial errors (Point A). This creates a continuous learning system that helps you identify and eliminate common denial patterns before submission.
As one implementation specialist explains: "Point D is *proof* that what you did in Point C to clean up the initial effort in Point A can instruct you how to treat all future 'Point As' so you can skip Point B straight for Point D."
2. X-Ray Vision Into Claim Issues
The "x-ray mode" allows you to compare original claims with the subsequent paid claims, clearly showing what changes were required for payment. This powerful feature helps billing teams understand exactly what needs to be corrected in future submissions.
3. Opportunity Dashboard for Systematic Improvements
Prevent organizes denial patterns into *opportunities* that show all claims with the same criteria. For example, you might see an opportunity showing all claims with a specific procedure code and modifier combination that received the same denial code. This systematic view allows you to address entire categories of denials rather than working them one by one.
Implementing Rivet Prevent into your denials workflow can impact key performance indicators:
- Decrease in initial denial rate
- Increase in clean claim rate (percentage of billed claims not requiring follow-up)
- Acceleration of cash flow by avoiding denials in the first place
- Decrease in cost-to-collect
- Improved denial recovery rate
On average, Rivet customers achieve a 20% year-over-year reduction in their denial rate. Some healthcare organizations using proactive denial prevention systems have seen a 6-to-1 return on investment.
Rivet Prevent doesn't just provide technology—it helps transform your approach to denials. Rather than accepting denials as an inevitable part of the revenue cycle, teams can build a prevention-focused culture that addresses issues at their source.
As teams use Prevent, they develop:
- Better documentation of processes for resolving specific denial reasons
- Increased awareness of which claim corrections result in payment
- Systematic approaches to implementing billing edits based on denial patterns
- Enhanced ability to track denial trends by payer, procedure, or provider
The shift from denial management to denial prevention represents a fundamental improvement in revenue cycle operations. By implementing Rivet Prevent alongside your existing denials workflow, you can reduce the burden on your appeals team, accelerate cash flow, and capture more of the revenue you've earned.
Rather than spending resources chasing denied claims, your team can focus on proactive measures that increase first-pass payment rates and improve overall financial performance. The result? Less time spent on rework, faster payments, and millions in recovered revenue that might otherwise be lost to preventable denials.
If your organization is struggling with the financial impact of denials or the overwhelming workload of appeals, it's time to see Rivet Prevent in action. Schedule a personalized demo to discover:
- Your Prevention Potential: Get a customized analysis of your specific denial patterns and the potential revenue impact of prevention
- X-Ray Vision in Action: See how our technology compares original and paid claims to reveal exactly what changes drive payment
- ROI Calculator: Understand the potential 6-to-1 return on investment based on your organization's unique denial profile
- Implementation Roadmap: Learn how quickly you can integrate Prevent into your existing workflow without disrupting operations
Schedule a demo.
Join the healthcare organizations that have reduced denial rates by 20% or more and shifted from reactive denial management to proactive denial prevention.