Reducing Claim Denials by 30%: Real-World Results from Carevyn’s Revenue Cycle Automation

Claim denials are not new to modern health care, but the reasons are changing. Practices today are managing:

- Changing payer rules

- Constant coding changes

- Employee turnover

- Outdated manual billing practices

- Time-consuming claim corrections

- Incomplete or inaccurate patient information

- Documenting compliance and strict documentation measures in place

The smallest detail being overlooked in a claim — a missing modifier, wrong insurance ID, or expired authorization — can completely trigger a rejection of the claim.

The Hidden Costs of Claim Denials

A denied claim takes approximately 15–40 minutes to work through. Now multiply those minutes by hundreds or thousands of claims for the duration of a year.

Studies demonstrate:

• 60% of denials are preventable

• 90% of preventable denials stem from human errors

• Resubmitting corrected claims takes 2x longer to receive reimbursements

• Healthcare providers waste millions of dollars each year due to resubmitting claims

This is particularly the gap that Carevyn’s Revenue Cycle Management (RCM) tools is designed to fill.

Carevyn’s Real World Examples of Decreasing Claim Denials by 30%

Carevyn is not theoretically, Carevyn has been put to the test in the field.

At clinics, specialty centers, hospitals, and medical groups, our automation claims processing engine has produced a measurable impact:

✔ 30% Reduction in Claim Denials

It is worth noting that our customers have seen dramatic improvements as early as 60-90 days after deploying Carevyn.

Automated pre-submission checks will catch problems before claims hit payers.

✔ 50–80% Reduction in Manual Billing Tasks

Tasks like charge entry, coding validations, eligibility checks, claim submission became fully automated or semi-automated workflows.

✔ 2–3 Weeks Faster to Reimburse

With clean claims and easier payer acceptance, your cash flow improves dramatically.

✔ 100% Visibility into Billing Workstreams

Your staff will know instantly what claims need attention, what documentation is pending, and where coding mismatches occur.

These gains are not guesses, they have been realized by healthcare organizations importing Carevyn’s automation RCM experience.

How Carevyn’s Revenue Cycle Automation Works

The Carevyn platform is powered by AI, rule-based engines, and real-time validations. Here’s how each part works to the financial platform at Carevyn runs on AI, rule-based engines, and real-time validations. Let’s walk through what each individual component does to minimize claim denials.

1. Automated Eligibility & Benefits Verification

Before a claim ever reaches your billing team, Carevyn validates the following:

• Coverage Status

• Co-pays and deductibles

• Prior authorizations

• Payer rules

• Policy limitations

• Service-specific requirements

One of the biggest reasons for derails is invalid or outdated insurance.

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2. Intelligent Coding & Documentation Validation

Carevyn’s RCM tools perform intelligent audits on every encounter.

• CPT and ICD-10 coding is checked against one another.

• Modifiers are checked for validity.

• Completeness of documentation is confirmed.

• Payer rules for coding compliance are validated.

• Medical necessity is verified.

If there is anything that may cause a denial, a flag is raised to notify staff before they submit it.

3. Automated Claims Processing & Scrubbing

Each claim undergoes Carevyn’s automated scrubbing engine.

• Format validation.

• Field checks for missing information.

• Diagnosis - procedure linkages.

• Place of service conditions.

• NPI & taxonomy verification.

• Detection for duplicate claims checks.

If the claim is clean, it gets sent right away. If it is risky, we flag it, but certainly do not reject it.

4. Smart Claim Submission & Payer Optimization

Carevyn’s platform optimizes the submission of claims.

• Updates on payer rules are real time.

• Routing is automatic.

• Digital submissions cut down processing times.

• If a payer manifests transient issues, and they claim is denied and gets auto-filled in the accountable for the second-time, we will re-submit it automatically.

These are just a few examples of how Carevyn does its part to guarantee clean claims.

5. Analysis of Denial Patterns Based on Artificial Intelligence

Even after automated denials, Carevyn continue to investigate:

• Payer actions

• Patterns of denial codes

• Delays in timing

• Categories of claims that are high-risk

• Financial impact

Every month your team will build a report to identify trends and actionable improvement areas.

6. Automated Appeals & Follow-up

If a denial is still issued, Carevyn speeds up the recovery of that reimbursement through:

Auto-generated appeal letters

• Pre-filled payer forms

• Tracking date deadlines

• Smart routing and triaging into the billing queue

• Recommendations on evidence/documentation

• A significantly faster denial time to payment.

Transparent Compliant & Secure Automation

Healthcare organizations trust Carevyn because we are:

✔ HIPAA Compliant

Secure end-to-end encryption, access control, and proected data.

✔ Auditable & Transparent

Every action that is done automatically can be tracked and documented.

✔ Payer-Validated

All rules and rules are updated automatically as payers make changes.

✔ Customizable

Practices can configure their own rules, approvals, and workflows.

✔ Human-in-the-loop-safe

Automation of any type does not conflict with your billing team. Rather, it enhances accuracy while reducing work.

Why Carevyn Beats Other RCM Tools?

RCM software is usually focused on managing claims (post-encounter). Carevyn is focused on preventing validity denials at the source.

Here is what separates Carevyn from the other RCM tools:

1. One Unified Platform

There is no switching back and forth between tools. Everything is based on eligibility, coding, scrubbing, submission, and claims analytics.

2. Predictive Denial Prevention

Artificial intelligence learns from your claim’s history!

3. Autonomous Billing Workflows

Your personnel manage only exceptions; the remainder is handled by the system.

4. Real-Time Compliance & Coding Updates

Say goodbye to codes and rules that are not current.

5. Seamless EHR/EMR Integration

Everyone can use whatever works with them, and there is no disruption to clinical workflows.

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The Financial Impact: What Does a 30% Reduction in Claims Really Mean?

Let's put some numbers to it.

A mid-sized clinic submitting 4,000 claims/month would see:

• 400–600 denial

• $25–$40 Average time-to-rework/denial

• Thousands of dollars of delayed cash flow, and

30% reduction would mean:

• 150–200 denials less per month

• $3,000–$8,000 savings on reworks

• Faster cash flow—10–20 days faster

• Captured revenue that has been lost.

This could amount to $200,000–$500,000 in retained revenue for that organization annually, depending on the size of the practice.

This is why Carevyn’s automated claims processing is not just a convenience; this is a financial strategy.

Use Cases: Who Benefits most from Carevyn

• Primary Care Clinics: Eliminate your billing staff errors that come from high-volume visit cycles.

• Specialty Practices: Reduce your coding complexity issues automatically by performing timely documentation checks.

• Hospitals & Multi-Location Groups: Scale your business efficiently with fewer billing staff.

• Urgent Care Centers: Real-time eligibility verification reduces your financial risk.

• Behavioral Health & Therapy Centers: Monitor the more frequent documentation discrepancies that historically led to denials.

Any organization submitting claims would benefit from automation.

Step-by-Step: Your Path to Fewer Denials with Carevyn

Step 1: Connect Carevyn to Your EHR/EMR

Very little configuration; integrates with your existing processes.

Step 2: Turn on Automation Rules

Select eligibility verification, audit, submission rules, and more.

Step 3: Educate Your Team

Most personnel become competent with Carevyn in less than an hour.

Step 4: Denials Decrease Automatically

Your billing team sees immediate improvement in 30-60 days.

Step 5: Report and Optimize

Optimize based on denials and payers.

The Future of RCM Is Automated and Carevyn Is Leading It

Reducing claim denials is not about working harder -- it's about working smarter. With intelligent workflows, Revenue Cycle Automation, and accuracy powered by AI, Carevyn is helping healthcare organizations redesign their financial processes and reclaim lost revenues.

If you're dealing with high denial rates, slow payment, or manual billing delays, Carevyn serves as the tool your organization needs to have:

• Cleaner claims

• Faster payment

• Increased revenue

• Less administrative burden

• Complete visibility into billing

30% improvement in denials is just the beginning.

Carevyn is your long-term partner for improved, automated revenue cycles.

Frequently Asked Questions

1. How does Carevyn prevent claim denials?

Carevyn deploys AI and rule-based scrubbing to confirm eligibility, validate coding, flag missing information, and ensure claims are optimized prior to submission.

2. Do we need to change our billing team or process?

No. Carevyn complements your existing team; it is not a replacement.

3. Can Carevyn integrate with our EHR/PM system?

Yes. Carevyn integrates with all readily available healthcare systems with a minimum of effort.

4. Does Carevyn completely automate the claim cycle?

Carevyn automates:

• Eligibility verification

• Coding validation

• Claim scrubbing

• Claim submission

5. How fast can we see results?

Most practices experience measurable denial reductions within a 30-90 day period.