Sift Healthcare

Denial appeal automation delivers speed, but not change. With the proliferation of LLMs, denial appeal automation has become part of every revenue cycle vendor's pitch. Feed the model the denial, the clinical record, the payer's own policy language, and i

DRG downgrade prevention is the use of clinical, claim and payment data to identify documentation and reimbursement risk before a claim is submitted. Its effectiveness should be measured by revenue retained and the cost of intervention, not denial rate al

Denial rates don't move because a software platform has a dashboard. They move because specific decisions inside specific workflows change, like which claims get scrubbed before submission, which denials get worked first, and which underpayments get caugh

If you're trying to prove a tool is working, or trying to figure out if the one you have is worth renewing, the revenue cycle performance metrics that matter split into three categories: 1) what $$ came back, 2) what it cost to get it back, and 3) whether

Every health system has a number it never sees. It's the distance between what you could collect on the care you delivered and what you actually keep after payers are done with the claim. We've started calling it the capture gap, because "denials" underse

Sift's Payments Intelligence Team does deep dives on adverse payment outcomes, like payer takebacks, looking beyond standard denials and examining payer behavior and reporting gaps to outline how hospitals can respond and prevent revenue loss. Payer takeb

Sift proprietary MS-DRG playbooks are a key component of the RevProtect Actionability Engine, helping health systems move beyond retrospective denial reporting and risk prediction to actionable, DRG-specific denial prevention. A 65-year-old patient, three

Actionability is where denial analytics become revenue. Payment Intelligence and predictive analytics report the problem. Actionability solves it, capturing lost hospital revenue through agentic and human intervention. Denial analytics is the one thing mo

6 Places Where Payer Policy Changes Actually Show Up First. A new survey from HFMA highlights that 68% of provider leaders named payer policy changes that aren't reflected in contracts as their top source of revenue leakage. Inconsistent payment practices

Make Copilot, ChatGPT and Claude work with your Hospital's denials data right away. Most hospital revenue cycle teams already have AI tools. Almost none are using them for denial management. If your health system runs Microsoft 365, your revenue cycle tea