Claim Denial Appeal for Prior Authorization Specialists with Change Healthcare
The Problem
Utilization Management denials pile up in CoverMyMeds — each appeal takes 45 minutes of billing-team time and most die in the to-do pile because there aren't enough hours.
What We Build in Change Healthcare
AI classifies denials by reason code, drafts the appeal letter with chart-cited clinical support, resubmits with corrected info, and tracks the payer response — appeal capture rate doubles. Purpose-built for teams running Change Healthcare — uses the native API or agent integration so nothing leaves the system of record.
Change Healthcare Integration Approach
Audit your Change Healthcare configuration
We map the specific Change Healthcare objects, custom fields, and workflows the automation needs to touch for your utilization management practice.
Build on the Change Healthcare API or agent
Integration happens inside Change Healthcare — no data leaves the system, no parallel tool for your team to learn, no license changes.
Human-in-the-loop handoff
Every automation routes exceptions back to a human in Change Healthcare with enough context to act — AI handles the 80%, your team owns the judgment calls.
See this running in your Change Healthcare instance
30-minute call. We'll look at your actual Change Healthcare setup and show exactly how this workflow fits.