Denials Navigator
Don’t Just Manage Denials. Get Ahead of Them.
Rural healthcare teams put a lot of work into managing denials. But when the same issues keep recurring, the bigger question becomes: What’s causing them in the first place?
That’s where we can help.
Denials IQ and Denials Navigator work together to help your team move upstream, using your data to identify what’s driving preventable denials and make practical changes to the processes behind them. Along the way, we also help build financial literacy across your team, connecting day-to-day processes to their financial impact on the organization.
The goal isn’t just to address the denial in front of you. It’s to prevent more denials, protect revenue, and help your team better understand their role in your hospital’s financial sustainability.
What Is Denials Navigator?
Denials Navigator is a denial prevention initiative for rural and community hospitals. It is analytics combined with root-cause analysis and change management. That way, your team has the resources to fix denials before they happen. A dashboard tracks denial intervention results, so you can watch denials fall and spend less staff time on rework.
Using the patterns identified through Denials IQ, we help your team decide which denial areas to tackle first based on factors like financial impact and potential for improvement. That might lead us to registration and eligibility, medical necessity, high-cost imaging, lab orders, provider documentation and coding, or another area specific to your organization.
From there, we work alongside your team to make improvements where they’re needed. Through targeted training, coaching, and changes to day-to-day workflows, we help your team address the root causes of recurring denials and build the skills and practices to prevent them long after the project ends.
When the work involves provider documentation and coding, trusted data makes those conversations easier. A claim-level view of which codes are being denied and what those denials cost the hospital gives your team and your providers the same set of facts to work from, so the discussion stays focused on fixing the process.
And the goal is bigger than improving one denial category. Your team learns how to work through the process with us, giving them a sustainable approach they can use again when other challenges arise. Over time, that builds greater confidence and capability within your organization to prevent denials and keep improving.
Why Rural Healthcare Organizations Choose REDi Health
Finding an opportunity in the data is only the beginning. REDi Health brings together analytics, process improvement, and change management to help rural healthcare teams act on what they learn.
- We Show You the Pattern, Not Just the Claim
Improvement conversations are more productive when they’re grounded in what’s actually happening.
We use timely, accurate data to move beyond assumptions and give your team an objective starting point for the conversation. Instead of pointing fingers, we can review the same information together and ask a more productive question: What can we learn from this?
- We Navigate the People Side of Change
Knowing where denials are happening is only the first step. Fixing them requires people across the organization to understand what’s driving the problem — and what they can do differently.
Denials Navigator helps hospitals turn denial insights into action. We work alongside your team to identify the workflows, processes, and behaviors contributing to denials, then help the right people make practical changes that stick. Using your own denial data as the guide, we help teams:
- Find out what’s causing the same denials to keep happening
- See where communication or processes are breaking down between departments
- Focus on the issues that are costing your hospital the most
- Help staff understand their role in preventing denials
- Use the data to see what’s improving and where more work is needed
- We Build on What’s Already Working
Improvement isn’t always about finding what’s going wrong. Sometimes, the best answers are already within your team.
We look for the practices that are leading to strong results and help bring those lessons to the rest of the team. That gives you a practical starting point based on what’s already working in your organization.
Our Approach to Denials Navigator
01
Identify Where to Start
We start with what we’ve learned through analyzing Denials IQ data to understand which denial areas have the greatest impact. From there, we work with your team to choose a starting point that fits your organization and priorities.
02
Dig Into the Process
Once we know which denial driver your team wants to tackle, we look beyond the denial itself to understand what's happening upstream. Depending on the issue, we may look at workflows, day-to-day practices, payer requirements, documentation, or training needs. We also look at how physicians work with registration, coding, and billing teams. Sometimes, small communication gaps or differences in how information is shared can contribute to denials. A closer look at how these teams work together can help us find opportunities to streamline processes and prevent future denials.
03
Put Change Into Action
We work with your team on what we learned about your denial trends and turn them into practical changes. We work with your team to address the processes contributing to recurring denials, with targeted training to help staff put those changes into practice. We also look within your organization for people and processes that are already seeing strong results. Understanding what they’re doing well gives us a practical model to build from and helps bring those successful practices to the rest of the team. From there, we coach your team through putting changes into practice, helping people understand not only what needs to change, but why it matters and how it fits into their day-to-day work. And just as importantly, we help those changes stick. Through hands-on coaching, timely feedback, and continued support, your team builds the skills and confidence to make new practices part of their everyday routines. The goal is to create lasting improvements that your team can maintain and build on long after our work together ends.
04
Project the Financial Impact
We want your team to understand what these changes could mean for your hospital financially. Using your denial data, we project the additional revenue your organization could receive by putting the recommended improvements into practice. This helps your team understand the potential financial return and the long-term value of preventing denials before they happen.
Where Can Denials Navigator Focus?
Your data helps determine where Denials Navigator should focus. Some of the most common areas we work in include:
- Registration & Eligibility
- Medical Necessity
- Emergency Department
- High-Cost Imaging
- Lab Orders
- Physician Documentation & Education
And this is just a starting point. If your data points us somewhere else, we’ll follow it and determine the best path forward with your team.
What We Evaluate
Our evaluation may include:
- Current performance and workflows: We start by looking at your denial data to establish a baseline so that we can measure the impact of any changes made. We also review how work gets done today and compare current practices with industry best practices and applicable Medicare coverage requirements, including National and Local Coverage Determinations (NCDs and LCDs).
- Day-to-day practices: We look at how team members carry out the process and where a little extra support or clarity could make their jobs easier.
- Training and education needs: We identify where targeted education can help your team feel more confident and consistent in the process.
- What your highest performers are doing well: This is one of our key tactics. We identify the practices already leading to strong results within your team and use them as a model to help everyone elevate their performance.
- How changes are working: Once something new is put into practice, we compare performance against the original baseline to understand what’s improving, build on what’s working, and adjust what isn’t.
Expected Outcomes
The goal of Denials Navigator is to reduce or eliminate preventable denials, not simply identify problems or give your team another report to review.
By combining your denial data with hands-on support, we help your team make meaningful changes to the processes behind recurring denials. And just as importantly, we help build the skills and confidence to maintain those improvements over time.
What can your hospital expect?
- Fewer preventable denials
- Clearer roles and responsibilities
- More useful data
- A more confident team
- Skills that go beyond denials
- More revenue staying with your hospital
The value goes beyond fewer denials. Your team gains stronger processes, practical skills, and a better understanding of how to keep improving long after the engagement ends.
The exact deliverables will depend on the work completed, but may include:
- A foundation for measuring progress: A baseline of denial performance and measures your team can use to evaluate improvements, including early results where available.
- Projected financial impact: A report projecting the financial return from the improvements over an agreed-upon period, including savings from reduced denial rework, so your team can see what the changes are worth to your organization. Actual results build over the months that follow.
- Data-informed change management and practical tools: Hands-on support to help your team turn data into action, implement changes, and sustain improvements. Materials developed through the project may include process maps, scorecards, educational resources, and other tools your team can continue using.
- A clear plan for sustaining improvements: Guidance on what worked and what may still need attention, so that your team can know where to go next. You’ll have defined ownership and accountability so everyone knows who is responsible for keeping each change in place.
- Data and analytics literacy: Training that helps your team understand where its data comes from, how the pieces connect, and how to interpret and use it to make informed decisions.
Engaging REDi Health at the State Level?
REDi Health can provide visibility into work across participating rural healthcare organizations and the progress made throughout the engagement.
Depending on the scope of the program, this may include:
- Reporting on project activities and progress
- Insight into interventions being implemented
- Measurement of outcomes and impact
- Projected financial returns based on the improvements made
- Information to support program oversight and reporting requirements
- Visibility into how participating organizations are using data to drive improvement
Denials Navigator in Action
That training is now used to onboard registration staff—something we hadn’t anticipated but is now a huge benefit.
Case Study: From $1.2 Million in Registration Denials to $0
Blue Mountain Hospital used Denials Navigator to identify the root causes of recurring registration denials and make targeted process changes.
The impact:
- $1.2M in registration denials before the project
- 68.6% reduction year over year
- $0 in registration denials after falling from a $400,000 quarterly peak
The work also led to new training and internal processes that Blue Mountain still uses today.
A True Partnership in Denial Improvement
Some of our favorite moments working with rural hospitals come from sitting down with their teams and hearing how they do things. There’s so much innovation and experience already within these organizations, and we love finding ways to build on it.
We use your hospital’s denial data alongside what your staff knows from working through these processes every day. Their input helps us understand what’s working well and where a change might be helpful. We also spend time on training and follow-up, so your team has documented processes to rely on, knows how to spot recurring denial issues, and can use the data to make adjustments without needing outside help each time.
That collaboration also builds understanding of why you’re making a change, so it’s more likely to become part of how your team works every day. Our goal is not only to help prevent denials before they happen, but to leave your team better equipped to keep improving long after our work together ends.
What's Next? Reinvesting in Your
Hospital's Future
The financial benefits of Denials Navigator don’t have to stop here. When your hospital prevents avoidable revenue loss and reduces time spent reworking claims, you can put those dollars and resources to work elsewhere.
That might mean strengthening another part of your revenue cycle, investing in new services, or supporting initiatives that help close gaps in care for your community.
At REDi Health, we offer additional services to help you build on those improvements and create opportunities for greater financial sustainability and continued growth.
Denials Navigator Maintenance Subscription
We'll continue looking at your denial data to see how much of the projected financial return your hospital is actually seeing. We'll also keep an eye on any issues that start showing up again and help you decide which denial area is worth tackling next.
Chargemaster Optimization
We help improve chargemaster accuracy, strengthen charge capture, and identify opportunities for more appropriate reimbursement. These insights can also help inform budget decisions and support investments in your chargemaster and related revenue cycle improvements.
Contracts IQ
Once you've strengthened your internal revenue cycle processes, it's worth taking a closer look at what your payer agreements mean for your hospital's financial performance. Contracts IQ gives your team greater visibility into reimbursement agreements, helping you understand how contract terms may affect revenue and where opportunities for improvement exist.
Contracts Navigator
Understanding your contracts is one thing. Putting that information to work is the next step. Contracts Navigator helps your organization act on those insights through focused support and practical improvements that strengthen your approach to payer contracts and reimbursement.
Beyond the Revenue Cycle: Clinical & Operational Improvement
The opportunities don’t stop with financial performance. As your hospital strengthens its revenue cycle, those improvements can create room to invest in other priorities that matter to your team and community.
Beyond financial sustainability, REDi Health helps rural hospitals use their data to make meaningful clinical and operational improvements. Whether that means identifying gaps in patient care, strengthening day-to-day processes, or preparing for value-based care, we work alongside your team to turn insights into changes that benefit your hospital and the community it serves.
FAQs
Denials IQ is the map. It looks at all of your denials together to show where they’re concentrated and which ones cost your hospital the most.
Denials Navigator uses that map to do the work that follows. We focus on the area driving the most denials or the one where a fix would have the biggest impact. From there, we work with your team to find the gaps in specific workflows and correct them, without assigning blame. The goal is to bring every team and process up to the level of your best performers, so denials are prevented before claims go out.
We recommend starting with Denials IQ, especially if your organization needs greater visibility into its denials or help deciding which opportunities to prioritize. It gives us the data and insight to determine the best place to start.
If you already know the specific denial issue or opportunity you want to tackle, though, we can move directly into Denials Navigator and begin working on that area.
Reworking denials focuses on getting individual claims paid after they’ve been denied. Denials Navigator focuses on prevention.
We use data to identify what’s causing denials and work with your team to improve the processes behind them. Reducing initial denials helps your facility receive payment sooner, lower days in accounts receivable, reduce rework costs, and limit bad debt. These improvements help your team prevent recurring problems and sustain results over time.
By reducing rework costs and preventing lost revenue, these improvements can help the project pay for itself, with benefits that continue as your team sustains the changes.
Your data determines where we focus, so we can concentrate on the denial drivers that create the greatest opportunity for your organization. But we don’t come in assuming everything needs to change. We look at what your team is already doing well, what you’ve tried before, and where there’s room to build from there.
Just as importantly, the people closest to the work are part of the process. We involve your team in understanding what’s contributing to the issue and work through the change together rather than making recommendations from the outside.
That means the engagement goes beyond identifying what needs to change. We help your team put improvements into practice, measure what happens, and make adjustments along the way. In the process, your team builds the knowledge and experience to continue the work after the engagement ends.
This isn’t another assessment of what needs to change. It’s a structured way to help your team make the change.
Your team will have an improvement project built around your facility’s needs, with processes and tools you can continue using to sustain the improvements. We also help make your 835 payment and remittance data easier to understand and use to identify denial patterns and opportunities for improvement. Continued access to a maintained dashboard is available through paid maintenance.
You’ll better understand what drove the denials, what changed, and how to use your data to monitor progress, identify new issues, and keep improving.
Denials Navigator can work with any EMR system. We’ve recently worked with facilities using TruBridge (formerly CPSI/Evident), Epic, MEDITECH, and Oracle Health (formerly Cerner). We use data from your existing systems to help your team understand denials, identify root causes, and make lasting improvements, without switching EMRs.
Ready to Take a Closer Look at Your Denials?
You don’t have to figure out where to start on your own. REDi Health can help your team understand what’s driving recurring denials and build a practical path toward preventing them.
