DENIAL SHIELD

Stopping Revenue Loss Before It Starts

In today’s healthcare landscape, claim denials are no longer a minor inconvenience they are a growing financial threat to hospitals, health systems, and provider groups worldwide. In the United States alone, claim denials cost providers an estimated $260 billion annually, representing a 20 percent increase in just five years. Globally, the financial burden is even more staggering, with billions lost to avoidable errors, delayed payments, and payer policy shifts.

The Next-Gen AI Platform Redefining Denial Management

DenialShield is the next-generation denial management platform built for this reality. Combining agentic AI, real-time monitoring, and a continuous learning loop, DenialShield stops revenue leakage at the source, while dramatically reducing rework costs and administrative strain.

Healthcare organizations using DenialShield are seeing up to a 46 percent reduction in preventable denials, faster approvals, and measurable improvements in cash flow. This is more than technology it’s a strategic advantage for providers competing in an era of razor-thin margins and intense operational pressure.

The Denial Crisis in Healthcare

Denial Healthcare

Providers Report Increased Denials

77%

U.S. healthcare providers (2024)

Rework Cost per Denied Claim

$43.84

Average per claim

Denials as Share of Total Claims

10–15%

Reported by many providers

Key Cause: Administration

30%

Incomplete/incorrect data

Administration as Cause of Denials

Donut • 30%

Denial Increase (2024)

Bar • 77%

Denials as Share of Total Claims

Range • 10–15%

0%10%15%25%50%100%

The band highlights 10–15% range. The pointer shows estimated midpoint (12.5%) for visual context.

From the U.S. to the U.K.—No System Is Immune

Outside the U.S., similar patterns emerge. The U.K.’s NHS loses hundreds of millions annually to rejected claims from private payers and cross-border billing. In Australia, denial rates have increased by 12% in three years due to evolving insurer requirements. Even in emerging markets, where payer systems are less mature, claim errors and disputes lead to significant cash flow disruption. The reality is clear: the denial problem is not local-it is universal. Providers everywhere are struggling to keep pace with payer policy changes, evolving documentation rules, and new compliance mandates.

Global Perspective

How DenialShield Works

How It works

Features Designed for Success

Feature Highlights

Agentic AI Pre- and Post-Denial Agents:DenialShield employs specialized AI agents for both pre- and post-denial stages. Pre-denial agents prevent errors before they happen, while post-denial agents recover lost revenue with speed and precision.
Real-Time Claim Monitoring : No more waiting days to find out about issues. DenialShield gives providers a live view of every claim’s journey, reducing uncertainty and boosting operational control.
Dynamic Rule Adaptation : Payer rules change constantly. DenialShield updates its rule sets automatically, so compliance never falls behind.
Reduction in Preventable Errors : By eliminating nearly 46% of preventable denials, DenialShield saves providers not only money but also time and labor resources.

The Technology Behind DenialShield

At its core, DenialShield runs on agentic AI-a class of artificial intelligence that can autonomously complete tasks, adapt strategies, and learn from every outcome. Unlike static rules engines, DenialShield evolves continuously, incorporating machine learning, natural language processing, and predictive analytics to anticipate and prevent denials.

It is fully compliant with HIPAA, ISO 27001, and other global data protection standards. Every data exchange is encrypted, and audit trails are maintained for regulatory confidence.

DenialShield Tech

Features Backed by Technology

Features Benefits

ROI and Value Creation

Value ROI

Annual Claims Submitted

500,000

Total claims per year

Baseline Denial Rate

10%

50,000 denied claims

Rework Cost per Denied Claim

$43.84

Average per claim

Prevented Denials

46%

Saves over $1M annually

Annual Denied Claims Breakdown

Donut • 50,000

Rework Cost vs Savings

Bar • $2.19M / $1M

5-Year Cumulative Financial Benefit

Line • $6M+

Shows cumulative financial benefit over 5 years for a mid-sized provider.

Common Causes of Claim Denials

Missing or incorrect patient data
Outdated payer rules
Insufficient documentation
Coding errors
Late submissions
Eligibility and coverage issues

Claim Denials

Why AI Is the Future of Denial Management

AI-driven denial management is not a trend it is the inevitable future of revenue cycle optimization. With payer policies evolving faster than manual teams can adapt, only automated, learning-based systems can keep pace. DenialShield’s AI agents operate 24/7, never tiring, never missing a rule update, and always working to protect provider revenue.

AI-first DenialShield

24/7 AI AgentsNever tire, always update.
Continuous LearningAdapts to payer rule changes.
End-to-end CoveragePrevention → Recovery

Security & Reliability

HIPAA & ISO 27001 certified
End-to-end encryption
Redundant storage & DR
Continuous monitoring & uptime SLAs

% reduction in preventable denials

/7 AI operations

Cut costs, prevent denials

Let’s Take Your Healthcare Organization to the Next Level

Don’t let claim denials erode your bottom line. With DenialShield, you can prevent rejections before they happen, recover lost revenue faster, and future-proof your revenue cycle. Contact Scale Healthcare today to see DenialShield in action and discover how it can transform your organization’s financial performance.

DENIAL SHIELD

Stopping Revenue Loss Before It Starts

The Next-Gen AI Platform Redefining Denial Management

The Denial Crisis in Healthcare

Denial Healthcare

Providers Report Increased Denials

Rework Cost per Denied Claim

Denials as Share of Total Claims

Key Cause: Administration

From the U.S. to the U.K.—No System Is Immune

Global Perspective

How DenialShield Works

How It works

Pre-Denial Detection

Automated Appeals

Continuous Learning Loop

Real-Time Monitoring

Features Designed for Success

Feature Highlights

The Technology Behind DenialShield

DenialShield Tech

Features Backed by Technology

Features Benefits

ROI and Value Creation

Value ROI

Annual Claims Submitted

Baseline Denial Rate

Rework Cost per Denied Claim

Prevented Denials

Common Causes of Claim Denials

Claim Denials

Why AI Is the Future of Denial Management

AI-first DenialShield

Security & Reliability

Cut costs, prevent denials

Let’s Take Your Healthcare Organization to the Next Level

Don’t let claim denials

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