Denial Management Automation: Get Appeals Submitted and Followed Up

Denial management automation uses software to investigate denied claims, gather supporting records, prepare and submit the appropriate response, and follow up with the payer. Champ carries out that work across payer portals, documents, phone calls, and your EHR or billing system, using your team's approved guidance.

The outcome is concrete: an appeal or other appropriate request submitted with the required evidence, its receipt confirmed, and the latest payer response recorded where your team works. When information is missing, Champ can reach out to the provider. When the portal cannot answer a question, Champ can call the payer.

Start with the outcome you want

You do not need to map every click before getting started. Describe the work in plain English, identify the systems and records involved, and provide your submission and review requirements. For example:

For these denied claims, check the payer's reason, gather the relevant records, and prepare the appropriate response using our approved guidance. Get any required review, submit it, confirm receipt, and follow up until we have a decision or need to take another action. Update the billing record with the result.

Champ turns those instructions into a workflow that can use your existing software. You can start with one recurring denial scenario and expand as the process is validated. Staff spend less time finding documents, repeating data entry, and chasing status updates.

What Champ can automate in denial management

Get the denial reason and claim history together

Champ can retrieve the payer's stated denial reason, remittance information, claim status, and previous correspondence, then match that information to the billing record. Instead of someone opening several systems to reconstruct what happened, the relevant claim details are brought together for the next action.

That can include identifying missing documentation, an administrative discrepancy, or a request that needs review before submission. Champ follows the rules your team provides and flags situations that need a coding, clinical, or other authorized decision.

Gather the evidence and fill information gaps

Appeal preparation often means finding records in several places: the original claim, authorization details, visit documentation, payer correspondence, and proof of earlier submissions. Champ can locate and organize the documents required for the applicable request.

If a document or detail is missing, Champ can contact the appropriate provider or staff member, track the response, and add the information to the packet. Your team receives a clearer request for what is needed, with the relevant claim context already assembled.

Prepare and submit the response

Using your approved templates and instructions, Champ can prepare an appeal letter, complete payer forms, attach supporting records, and enter the required information in the portal. Required review or signatures remain part of the workflow.

After submission, Champ can capture the confirmation number, submission date, and receipt. Those details matter when a payer later asks whether the appeal was received or your team needs to locate the request.

Follow up through portals and phone calls

Submitting an appeal does not finish the work. Champ can revisit the payer portal, check for new messages or requests, retrieve the decision, and record the next step. If additional documentation is requested, the workflow can gather and submit it using your instructions.

When the portal gives an incomplete answer or the next step requires a conversation, Champ can call the payer to confirm receipt, ask about status, or clarify what information is missing. The result of that follow-up is added to the claim record.

Keep the EHR or billing system current

Champ can write the submission details, correspondence, status, and payer response back into your existing system. Your team can see what was sent, when it was received, what the payer said, and what still needs attention.

That makes the workflow useful beyond generating an appeal letter. It completes the administrative steps around the letter and keeps the working record aligned with the payer's response.

Corrected claim, reconsideration, or appeal?

These are related workflows, but they are not interchangeable. The appropriate route depends on the payer, plan, denial reason, and applicable process. Champ can follow your guidance for choosing and completing the right path.

• Corrected claim: Fix information on the original claim when the payer's correction process applies.
• Reconsideration: Ask the payer to review a claim decision through its reconsideration process, where available.
• Appeal: Submit a formal challenge with the explanation and supporting evidence required for that appeal.

For example, UnitedHealthcare's provider guidance describes separate correction, reconsideration, and appeal paths. The workflow should use the process that applies to the claim rather than assume every denied claim needs the same response.

Documentation also depends on the process. CMS guidance for a first-level Medicare fee-for-service appeal calls for an explanation of the disagreement and supporting documentation, submitted to the contractor responsible for the initial determination.

Champ can track the deadlines and submission requirements your team supplies for each workflow. Clinical arguments, coding changes, and decisions about whether to challenge a denial follow your approved guidance and required review.

Works across your existing portals and EHR

Denial work rarely stays inside one application. The payer's explanation may be in a portal, the supporting note in an EHR, and the submission history in a billing platform. Champ uses browser automation to move between those systems and complete the steps your team would otherwise perform manually.

Examples include Availity Essentials, UnitedHealthcare Provider Portal, and Medicare contractor portals, alongside EHR and billing platforms such as athenaOne and eClinicalWorks. These are examples of systems a workflow may involve, not a required software combination.

A prebuilt connector or custom API is not required for browser-based steps. Champ works through the access your organization provides, with documents and phone calls available when the workflow extends beyond the portal.

Explore our guides to Availity automation, athenaOne automation, and eClinicalWorks automation for related workflows.

Where denial automation fits in your revenue cycle

Practices, billing companies, and revenue cycle teams can use Champ for recurring denial work that involves document collection, data entry, submissions, and follow-up. A useful starting point is a repeatable scenario with clear instructions and a measurable administrative outcome.

Measure whether the required packet was assembled, the request was submitted on time, receipt was confirmed, and the latest response reached the billing record. Appeal outcomes still depend on the claim, supporting evidence, and payer decision; automation does not guarantee payment or an overturned denial.

Denial management also connects to claims follow-up and prior authorization. Champ can carry information between those workflows so staff do not have to rebuild the same claim history each time.

Frequently asked questions

What is denial management automation?

It is the use of software to complete work associated with denied claims, including collecting denial details, gathering evidence, preparing responses, submitting requests, and tracking payer decisions. Champ combines browser automation, document work, and phone calls to carry out those steps across your existing systems.

Can Champ automate medical billing appeals?

Yes. Champ can assemble records, prepare appeal letters using approved templates and guidance, complete forms, submit packets after required review, and follow up with the payer. It can also save confirmation details and responses in your billing system.

Can Champ call the payer if the portal is not enough?

Yes. Champ can make calls to confirm receipt, check status, clarify missing information, and obtain the next administrative step. The call outcome can be recorded alongside the portal and submission history.

Do we need to replace our EHR or billing software?

No. Champ works with your existing systems through browser automation and the access you provide. Your team can keep using the EHR, billing platform, and payer portals already involved in the process.

How do we get started?

Choose a recurring denial scenario, describe the desired outcome, and share the relevant process, templates, and access requirements. Champ can then be configured and validated for that workflow before expanding to additional denial types.

Get appeals submitted and followed up

Bring a denial workflow that is taking too much manual effort. Champ can help turn it into completed administrative work: records collected, the appropriate response submitted, receipt confirmed, and the payer's decision recorded.

Book a Champ demo to walk through your workflow.