Claim Dispute Management with Agentic Process Automation for a Specialty Infusion Provider
More Revenue Recovered a Year
Appeal Overturn Rate (up from 40%)
Less Effort per Appeal (60 to 20 minutes)
Industry
- Healthcare
Processes Automated
- Denial and remit intake
- Denial classification and prioritization
- Evidence assembly and appeal drafting
- Human review and approval
- Appeal filing and deadline tracking
Automation Highlights
- Document AI Agent (IDP) capturing reason codes, amounts, and deadlines
- AI agents ranking claims by recoverable value and drafting payer-specific appeals
- Humans approving every appeal before filing
- Agents filing appeals and alerting staff to deadlines at risk
A Specialty Infusion Provider
A specialty infusion provider treats thousands of patients a month across dozens of sites and bills dozens of payers. Each month, thousands of its claims come back denied or underpaid, each with a deadline for appeal. Staff read and keyed denials manually, researched each one across the EHR and billing system, and disputed claims stayed in accounts receivable for 62 days on average.
Nividous runs claim disputes in one governed workflow, with a human review gate before anything reaches a payer. The Document AI Agent (IDP) reads each denial, AI agents research and draft the appeal, a billing specialist approves it, and Agents file and track it.
Illustrative scenario: figures are modeled on 3,000 disputed claims a month, not measured customer results.
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