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Leading academic health system, Western U.S.
AI-APPEAL STRATEGIES

How one academic health system turned complex denials into a 91% win rate

This academic health system had a growing backlog of post-payment audits and clinical validation denials and a lean team that couldn't keep pace without adding costly clinical headcount. SmarterDenials changed the math, resulting in a 91% win rate and 61% more appeals submitted without adding clinical headcount.

Health system
Leading academic health system, Western U.S.
Scale
Over 100K patient discharges per year
Solution
SmarterPrebill and SmarterDenials
Primary workflows
Clinical validation and DRG downgrade appeals, complex inpatient denials

Executive summary

Facing an aging backlog of post-payment audits and rising denial volume, this health system needed a way to scale appeal writing without expanding their expert clinical staff. They put SmarterDenials to the test against their existing manual process and EHR-native tools. After a rigorous, data-driven evaluation, SmarterDenials became the clear choice for inpatient workflows. Check out the case study to:

  • See how the health system structured a head-to-head evaluation across overturn rate, appeal quality, speed, and payer-specific trends
  • Discover how SmarterDenials drove a 91% win rate, up from 74% with manual processes, while increasing appeal submissions by 61% — without adding clinical headcount
  • Learn why the team turned to SmarterDenials for complex DRG downgrade appeals — a capability they couldn't find elsewhere
  • See the broader financial impact: $50M+ in net new revenue from SmarterPrebill and $7.4M+ in annualized incremental revenue from SmarterDenials

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What changed operationally

Result methodology and context