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Denials Management Services 2024
Which Firms Are Helping Overturn & Prevent Denials?
Author
Mollie Hunt
Author
Jennifer Hickenlooper
Author
Braden Taylor
Healthcare organizations continue to face challenges with getting reimbursements, due in part to large volumes of complex medical claim denials issued by payer organizations. To access expertise in managing the appeals process, many healthcare organizations are engaging denials management services firms, who utilize multidisciplinary teams (e.g., legal, clinical, coding) to review accounts and submit appeals. This report—KLAS’ first on denials management services—examines which firms consistently deliver strong execution, expected overturn rates, expertise, and partnership in denials prevention.
Aspirion & Revecore* Provide Consistent Client Experiences by Efficiently Managing Appeals, Meeting Overturn Rate Expectations & Utilizing Legal Expertise
2024 Best in KLAS winner Aspirion garners the highest client satisfaction among fully rated firms. Of respondents that reported on the firm’s overturn rates, all feel the firm meets or exceeds expectations in this area—which, combined with their speed in reviewing/submitting appeals, contributes to these respondents’ increased satisfaction and sense of value with the services. Many interviewed clients identify the firm’s legal expertise as a core, differentiating strength, as staff utilize legal knowledge to improve the quality and effectiveness of appeals letters and to provide useful feedback to clients. This access to legal expertise allows clients to realize greater efficiencies and success rates than would be possible internally. A few respondents indicate execution misses as their engagement progressed due to inadequate staffing for the volume of work. All but one Revecore* respondent is satisfied or highly satisfied, and all would purchase the services again. The firm is noted for quickly handling appeals, providing thorough documentation, and managing difficult accounts while maintaining overturn rate expectations. Respondents highlight the quality of staff, citing their level of detail, continuity over time, and expertise; a few specifically attribute their trust in Revecore to the exceptional staff on their accounts. The one dissatisfied respondent notes missed expectations on working lower balance accounts.
*Limited data
R1 RCM & Xsolis* Effectively Handle Denials for Majority of Respondents, despite Some Variability in Client Experience
The majority of interviewed R1 RCM clients are highly satisfied with the firm’s efficiency and overturn rates. Further, half of respondents indicate the firm exceeds their expectations with overturn rates. The firm is highlighted for their willingness to take on challenging denials, their ability to handle large volumes, and their timeliness in submitting appeals. Satisfied respondents highlight the firm’s legal and clinical knowledge when crafting arguments and making appeals; some also feel R1 RCM’s resources provide helpful insights and feedback. A few respondents are dissatisfied because of execution issues related to lacking resources or expertise. Additionally, a couple see room for improvement in the firm’s consistency through additional training and QA. Even with the variability in the client experience, 95% of respondents report they would buy R1 RCM’s services again. Feedback from Xsolis* respondents presents a highly bifurcated experience, with 63% reporting high satisfaction at an average of 49.1 points higher (on a 100-point scale) than the 37% of dissatisfied respondents. Highly satisfied clients report timely turnaround that helps them realize improved metrics and high cash returns. Some say the firm stays on top of necessary legal and regulatory knowledge, specifically mentioning the firm’s clinical expertise and judgment and thorough physician reviews. Dissatisfied Xsolis clients feel the firm is sometimes too slow or falls behind, negatively impacting A/R; a few also point to inconsistent staff knowledge. Still, all respondents appreciate the helpfulness and responsiveness of their Xsolis account representatives.
*Limited data
Aspirion’s Denials Prevention & Revecore’s* Collaboration Lead to Deeper Strategic Partnerships; R1 RCM’s Leadership & Attention to Clients Drive Strong Relationships
While the core of a denials management engagement is overturning active denials, healthcare organizations want additional help from their firms in preventing future denials—even though a reduction in denials may decrease future volumes of work for the firms. Further, respondents often identify denials prevention guidance as a key element in a strategic partnership. Aspirion is highlighted for aiding organizations in denials prevention; respondents report the firm has regular client conversations to discuss performance as well as trends and strategies for improving organizational processes. Additionally, respondents note they receive specific education from the firm through lunch-and-learn series, case study reviews, and appeal letter templates and examples. Interviewed Revecore* clients report high levels of strategic ability and partnership, with many highlighting the firm’s responsiveness and collaboration. Almost all Revecore respondents mention the firm’s denials prevention, even some who didn’t respond to the specific question about denials prevention. These respondents specifically point to the firm’s root-cause analyses and case studies, where accounts are thoroughly examined to identify potential solutions and prevention measures. Interviewed clients of R1 RCM feel the firm’s leadership is key to their strong partnerships, noting the firm listens to clients and tailors services to meet client needs. The most-satisfied clients highlight R1 RCM’s assistance in improving processes and preventing denials, while others would like increased guidance in reducing future denials.
*Limited data
Across the Market, Firms Have Opportunity to Enhance Consistency & Depth of Reporting
Across clients from all measured firms, there is a common desire for more trending data (i.e., payer, claim type) and more granularity around performance insights. Even respondents who are currently satisfied with their firm’s reporting have asked for additional insights to help them navigate the payer landscape and their own operations. While each firm is generally delivering on these requests, this trend points to a process that is currently more reactive than proactive, contributing to inconsistent reporting experiences for clients.
Note: KLAS began asking about client sentiments toward their firm’s reporting in July 2023. Thus, the sample size is smaller than elsewhere in the report. KLAS will continue to monitor and report on client satisfaction with reporting.
About This Report
Each year, KLAS interviews thousands of healthcare professionals about the IT solutions and services their organizations use. For this report, interviews were conducted over the last 12 months using KLAS’ standard quantitative evaluation for healthcare services, which is composed of 9 numeric ratings questions and 3 yes/no questions, all weighted equally. Combined, the ratings for these questions make up the overall performance score, which is measured on a 100-point scale. The questions are organized into five client experience pillars—loyalty, operations, relationship, services, and value.
To supplement the performance data collected, KLAS also asked interviewed clients the following questions specific to denials management:
- How does the firm’s overturn rate compare to the expectations that they set with you?
- Rate your satisfaction with how quickly your firm handles appeals.
- Rate how well your firm’s reporting meets your needs.
- Rate your satisfaction with the legal/regulatory expertise your firm applies to the appeals process.
- Rate your satisfaction with the clinical expertise your firm applies to the appeals process.
- Rate how well your firm helps you prevent denials in the future.
Sample Sizes
Unless otherwise noted, sample sizes displayed throughout this report (e.g., n=16) represent the total number of unique customer organizations interviewed for a given vendor or solution. However, it should be noted that to allow for the representation of differing perspectives within any one customer organization, samples may include surveys from different individuals at the same organization. The table below shows the total number of unique organizations interviewed for each vendor or solution as well as the total number of individual respondents.
Some respondents choose not to answer particular questions, meaning the sample size for any given firm or service can change from question to question. When the number of unique organization responses for a particular question is less than 10, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 6, no score is shown. Note that when a firm has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.
Writer
Carlisa Cramer
Designer
Jessica Bonnett
Project Manager
Sydney Toomer
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2026 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.