Top 10 Denial Management Software Solutions for Multi-Location Groups in 2027

Introduction

A VP of Revenue Cycle at a 30-location specialty group opens the month-end aging report and sees the same pattern as last month. Denials are climbing faster than collections, and a growing share in the 90-plus-day bucket will never be worked. The billing team is the same size it was 2 years ago. Claim volume is not.

Every denied claim needs someone to read it, find the reason, call the payer, fix the claim, and track it until it is paid or written off. At group scale, that work outruns any billing team. The groups getting ahead of it are not hiring their way out. They stop the preventable denials at the front end and work the rest on the back end, in one connected workflow.

This guide covers what drives denials for multi-location groups, what to look for in denial management software, a comparison of 10 platforms, and how to choose.

What Denials Cost Multi-Location Groups

The dollars are large

A Premier survey cited by the American Hospital Association estimated that providers spent $19.7 billion in 2022 trying to overturn denied claims.

Initial denial rates are high

The same survey found that nearly 15% of claims submitted to private payers are initially denied, including 15.7% of Medicare Advantage claims and 13.9% of commercial claims.

Most denials can be won, at a cost

The survey found that 54.3% of denied claims are eventually overturned, often after multiple rounds of appeals. Every round costs staff time.

The trend is getting worse

In a March 2024 MGMA Stat poll, 60% of medical group leaders reported higher claim denial rates than the year before.

Scale multiplies the work

A denial process that one office runs on a spreadsheet breaks across 10 or more locations, where payer mix, contracts, and appeal deadlines differ by site and service line.

Prevention and recovery need to connect

Stopping a denial before submission and recovering one after the fact use different steps. When they run in separate tools, the lessons from recovered denials never reach the front-end checks that could have prevented them.

What to Look for in Denial Management Software

• Prevention. Whether the platform verifies eligibility, confirms authorizations, and checks claims before submission using payer-specific rules.
• Recovery. Whether it contacts payers, corrects and resubmits claims, and tracks appeals through to resolution, or leaves that work on staff.
• Root-cause classification. Whether denials are grouped by reason, such as eligibility, authorization, coding, timely filing, or medical necessity, so the group can fix upstream causes.
• Integration. Whether results write back to the EHR, PMS, and clearinghouse systems the group already runs.
• Reporting by site and payer. Denial trends and recovery results by location, payer, and service line.
• Fit for group scale. Whether the platform is built for multi-location groups or sized for hospital systems.
• Security and compliance. HIPAA compliance and a Business Associate Agreement.

Comparison Table: Top Denial Management Platforms at a Glance

Top 10 Denial Management Software Solutions

1. Confido Health

Overview

Confido Health is the AI system of action for healthcare operations. Its AI Teammates handle both halves of denial management in one workflow, inside the EHR, PMS, and phone systems a group already runs. On the front end, they verify eligibility, copay, and deductible before the visit, check authorization requirements at booking, submit through payer and IPA portals, and reach patients whose coverage is missing or expired. On the back end, they classify each denial by reason, contact the payer to confirm what is missing, correct and resubmit the claim, and track the appeal to resolution. Staff step in when a case needs clinical or billing judgment, such as a peer-to-peer review, and every update writes back to the EHR or PMS.

Denial Prevention and Recovery Capabilities

• Eligibility, copay, and deductible verification before the visit, written to the patient chart
• Authorization requirement checks at booking, with portal submission, status follow-up, and renewal tracking
• Outreach to patients with missing or expired coverage before the visit
• Denial classification by reason, including eligibility, authorization, documentation, and timely filing
• Payer calls to confirm denial reasons and missing information
• Claim correction, resubmission, and appeal tracking through to resolution
• Denial reasons from recovered claims fed back into front-end checks, so the same denial does not repeat
• Reporting on denials and recoveries by location, payer, and service line

Key Integrations

Two-way integrations across 40+ EHR, PMS, and phone systems, including Epic, athenahealth, eClinicalWorks, NextGen, ModMed, and Veradigm, plus phone systems such as RingCentral, 3CX, and Mango Voice.

Strengths

Prevention and recovery run in one system, so the root cause of every recovered denial informs the checks that stop the next one. Calls come first: AI Teammates reach payers and patients directly, which closes the gaps that portal-only tools leave for staff. The same platform also runs scheduling, billing conversations, and collections, so a coverage gap found on a patient call can trigger a payer call and update the chart in the same workflow. Confido Health is HIPAA compliant and SOC 2 Type II certified.

Considerations

Confido Health is a full operations platform. Groups that only want an appeal letter generator, with no front-end prevention or payer calls, may find the scope larger than they need.

Best For

Multi-location groups with 10+ providers that want denials prevented at the front end and recovered at the back end, in one connected workflow.

2. Waystar

Overview

Waystar is a healthcare payments platform whose denial management is built around AI-generated appeals and prioritization of the denials most likely to be overturned.

Denial Management Capabilities

• AltitudeAI, which generates appeal letters with generative AI
• Predictive prioritization of denials most likely to be overturned and paid
• A library of more than 1,000 payer-specific appeal forms
• Paperless batch appeal submission with tracking and proof of delivery
• Auto Coverage Detection for eligibility-related denials
• Recoupment Manager, which matches post-payment adjustments to their original claims

Key Integrations

Integrates with EHR, hospital information, and practice management systems through its cloud platform.

Strengths

Waystar reports a 90% reduction in the time needed to create 100 appeal packages and a 40% higher overturn rate with AltitudeAI.

Considerations

Waystar focuses on appeals and payments. Payer and patient calls still fall on staff, so confirm how follow-up is handled when a denial needs a conversation.

Best For

Groups and health systems wanting AI-generated appeals and overturn prioritization inside a payments platform.

3. Experian Health

Overview

Experian Health's Denial Workflow Manager helps organizations manage denied, suspended, pending, and lost claims, combining work lists with claim status and remittance data.

Denial Management Capabilities

• Identification of denials, holds, zero pays, and appeals through remittance and claim status data
• Standard and payer-specific reason codes with descriptions
• Work lists by denial category and dollar amount
• Integration with ClaimSource, Experian's claims management platform

Key Integrations

Works standalone or with Experian's ClaimSource, Contract Manager, and Enhanced Claim Status products.

Strengths

Experian Health cites a Summit Medical Group Oregon case study reporting a 92% primary clean claim rate.

Considerations

Its strength is tied to Experian's own claims platform, so groups on a different claims system should confirm integration depth.

Best For

Organizations wanting denial work lists tied to claim status and remittance data.

4. AKASA

Overview

AKASA is a generative AI platform for revenue cycle work, with denials as one of its core use cases.

Denial Management Capabilities

• Generative AI for denial drafting and documentation support
• Workflows aimed at the denial categories revenue cycle teams report as most time-consuming
• Integration into existing revenue cycle systems

Key Integrations

Integrates with EHR and revenue cycle systems already in place.

Strengths

AKASA-commissioned research through HFMA's Pulse Survey program found that 76% of surveyed CFOs and revenue cycle leaders named denials management their most time-consuming revenue cycle task.

Considerations

AKASA publishes fewer quantified customer results than some competitors, so ask for outcomes specific to your payer mix.

Best For

Revenue cycle teams wanting generative AI applied to denial drafting and documentation.

5. Notable Health

Overview

Notable Health handles non-clinical prior authorization work, reducing authorization-related denials as a downstream effect.

Denial Management Capabilities

• Authorization submission and tracking with EHR updates
• Synthesis of clinical data to support authorization requests
• Dashboards on authorization performance
• Payer portal integration

Key Integrations

Integrates with EHRs, payer portals, claims and pharmacy data, and health information exchanges.

Strengths

Notable cites a Care New England case study reporting a 55% reduction in authorization-related write-offs and 80% faster authorization turnaround.

Considerations

Its denial impact is concentrated in the authorization category rather than across all denial types.

Best For

Organizations wanting authorization handling that reduces downstream denials.

6. Inovalon

Overview

Inovalon's Claims Management Pro is a claims and denial platform built around pre-submission claim scrubbing and multi-payer management.

Denial Management Capabilities

• Claim scrubbing against CMS and commercial payer rules before submission
• Secondary claims processing
• Centralized audit and appeals tracking
• Denial pattern analytics through the companion RCM Intelligence product

Key Integrations

Integrates with CMS and commercial payer rule sets, with single-login access to remittance data.

Strengths

Inovalon reports a 98%+ first-pass payer acceptance rate.

Considerations

The deepest denial analytics require the companion RCM Intelligence product, sold separately.

Best For

Large provider organizations wanting pre-submission claim scrubbing and multi-payer claims management.

7. FinThrive

Overview

FinThrive's Denials Prevention Manager uses machine learning to flag claims likely to be denied before submission.

Denial Management Capabilities

• Machine learning trained on large volumes of institutional and professional claims
• Root-cause identification across coding, documentation, authorization, and reimbursement
• Intervention inside FinThrive Claims Manager before a claim leaves the organization

Key Integrations

Integrates with FinThrive Claims Manager and FinThrive Fusion.

Strengths

Strong pre-submission prevention for organizations already on FinThrive's claims products.

Considerations

Built primarily for hospitals and health systems on FinThrive's platform, and focused on prevention rather than payer follow-up.

Best For

Hospitals and health systems wanting machine learning denial prevention inside a claims platform.

8. Optum

Overview

Optum's Assurance Reimbursement Management platform helps providers prevent denials and speed reimbursement through one of the largest payer networks in the industry.

Denial Management Capabilities

• Claim tracking from submission through payment
• Error identification before reimbursement is delayed
• Electronic submission of supporting documentation through Assurance Attach Assist
• Alerts and dashboards for claim status

Key Integrations

Connects to a large payer network with built-in claim edit packages.

Strengths

Broad payer reach across commercial and government plans.

Considerations

Sized for enterprise claims operations, so smaller groups should confirm implementation effort and cost.

Best For

Enterprise organizations wanting denial management inside a large claims and payer network.

9. R1 RCM

Overview

R1 RCM offers denials recovery that combines AI-assisted appeal drafting with clinical and legal staff, built on its Phare platform.

Denial Management Capabilities

• AI-assisted appeal drafting
• Payer contract intelligence
• Clinician-led validation before submission
• Attorneys, clinicians, and coders working complex denials

Key Integrations

Works across EHR and hospital information systems as an integrated revenue cycle service.

Strengths

R1 RCM reports a 90% average denial overturn rate across its clients.

Considerations

R1 RCM is an outsourced service model built for large health systems, with a different cost and engagement structure than software.

Best For

Large health systems wanting outsourced appeals with clinical and legal staff.

10. MDaudit

Overview

MDaudit's Denials Predictor reviews high-risk charges before payment, focused on high-dollar cases such as specialty drugs, implants, and complex diagnoses.

Denial Management Capabilities

• Payer-centric rules engine for high-dollar charges
• Pre-bill charge analysis
• Payer-specific explanations of risk
• Routing of flagged claims to revenue integrity staff

Key Integrations

A module within MDaudit's revenue integrity and audit platform.

Strengths

Focused risk review where a single denial carries the most dollars.

Considerations

Built for hospitals and ASCs with high-complexity claims, so groups with high volumes of lower-dollar claims should confirm fit.

Best For

Hospitals and ASCs wanting pre-payment risk review on high-dollar claims.

How to Choose

1. Map denials by reason and location. Group last quarter's denials by eligibility, authorization, coding, timely filing, and medical necessity, by site and payer.
2. Find your biggest gap. If most denials are eligibility and authorization, prevention pays first. If a backlog sits unworked, recovery pays first. Most groups need both.
3. Check the connection. Ask each vendor how lessons from recovered denials feed back into front-end checks.
4. Check who makes the calls. Many denials need a payer conversation. Ask whether the platform makes those calls or leaves them on staff.
5. Ask for a live demo in your systems. Watch a denial move from rejection to resubmission to payment.

Why Multi-Location Groups Choose Confido Health for Denial Management

Prevention and recovery in one workflow

Eligibility checks, authorization handling, payer follow-up, resubmission, and appeals run in one system, so a group is not stitching together a prevention tool and an appeals tool.

Every denial makes the next one less likely

Denial reasons from recovered claims feed back into the front-end checks, so the same eligibility or authorization gap does not cause the same denial next month.

The payer call gets made

AI Teammates call payers to confirm denial reasons and missing information, the step that stalls most denials when it waits on staff.

Billing team time moves to judgment calls

When AI Teammates take payer follow-up and resubmission, the billing team spends its time on peer-to-peer reviews, complex appeals, and contract disputes.

Final Thoughts

The right denial management software depends on where your denials start and where they stall. Waystar and AKASA go deep on appeal drafting. Experian Health and Inovalon bring claims platform depth. Notable Health focuses on authorization. FinThrive, Optum, R1 RCM, and MDaudit serve hospital-scale operations. Confido Health is built for multi-location groups that want denials prevented at the front end and recovered at the back end, in one connected workflow with the payer calls handled.

Before you choose, map your denials by reason, location, and payer, and ask each vendor to show a denial moving to payment in your own systems. For related reading, see our guide to coordinating scheduling, billing, and follow-ups.

See Where Your Denials Start

Running 10+ locations or providers? Send us last quarter's denials by reason and payer, and we will show you which ones Confido Health would prevent and which it would recover first.

Book a demo or browse our specialty webinars.

Frequently Asked Questions

What is denial management software?

Denial management software helps a group prevent claim denials before submission and recover denied claims after the fact, through classification, payer follow-up, resubmission, and appeals. Confido Health handles both prevention and recovery in one workflow.

What is the difference between denial prevention and denial recovery?

Prevention stops a denial before the claim goes out, mostly through eligibility verification and authorization checks. Recovery works denials that still happen. Confido Health runs both and feeds denial reasons from recovery back into prevention.

How does Confido Health handle a denied claim?

Confido Health AI Teammates classify the denial by reason, call the payer to confirm what is missing, correct and resubmit the claim, and track the appeal to resolution. Cases that need clinical judgment go to the right staff member with the full case attached.

What causes most claim denials?

Common causes include eligibility issues, missing or incorrect authorizations, coding errors, timely filing misses, and medical necessity disputes. Eligibility and authorization denials are often the most preventable, which is why Confido Health checks both before the visit.

Can one platform handle prior authorization and denials together?

Yes. Confido Health handles authorization requirement checks, submission, and status follow-up alongside denial recovery, so authorization-related denials are both prevented and worked in the same system.

Which systems does Confido Health integrate with?

Confido Health integrates with 40+ EHR, PMS, and phone systems, including Epic, athenahealth, eClinicalWorks, NextGen, ModMed, and Veradigm, and writes every denial update back to the chart or PMS.

Does Confido Health replace the billing team?

No. AI Teammates take payer follow-up, resubmission, and tracking, so the billing team spends its time on complex appeals and cases that need judgment.

Is Confido Health HIPAA compliant?

Yes. Confido Health is HIPAA compliant, SOC 2 Type II certified, and signs a Business Associate Agreement with every customer.