Top Ways Healthcare Organizations Can Reduce Denials: A Results-Driven Checklist

Denials happen—but they don’t have to be a constant headache. With the right tools, processes, and team alignment, healthcare organizations can prevent many denials before they occur and create a more connected, resilient revenue cycle. This checklist highlights practical, proven ways to reduce denials and maximize revenue. 

1. Verify Eligibility and Benefits Upfront With Real-Time Tools 

• Many denials start with missing or incorrect patient information. Use real-time eligibility verification to confirm insurance coverage, benefits, and active status at the point of registration. This not only prevents eligibility-related rejections—it also helps increase front-end collections. 

2. Automate Prior Authorization Workflows 

• Missed or delayed authorizations—like retro authorizations for clinic-administered meds—are a leading cause of denials. Automating prior auth workflows helps your team stay on top of payer requirements, reduce manual follow-up, and ensure approvals are in place before services are delivered.  

3. Educate and Align Front-End Staff 

• Registration and intake teams are your first line of defense. Establish standardized registration fields and equip staff with up-to-date payer knowledge to avoid costly errors from the start. 

4. Use Claims Scrubbing and Edits 

• Catch errors before they become denials. Analyze claim scrubber messages to see what can be improved in registration and coding workflows. 

5. Monitor Denials With Actionable Dashboards

• Visibility is key. Use dashboards to track denial trends by type, department, or payer—then turn insights into targeted interventions. 

6. Standardize Documentation and Coding Practices 

• Consistent, compliant documentation helps ensure accurate coding and supports medical necessity. Regular audits and provider education can reduce clinical denials. 

7. Prioritize Root Cause Analysis 

• Denial prevention starts with understanding why they happen. Focus on high-volume denial reasons and take a cross-functional approach to resolving root causes. 

8. Appeal Strategically

• Not all denials are worth chasing. Prioritize appeals based on financial impact and likelihood of success, and use automation to streamline repetitive tasks. 

9. Keep Pace With Payer Changes 

• Payers frequently update their rules. Build regular payer policy reviews into your workflows so your teams can stay proactive, not reactive. 

10. Foster Collaboration Across Teams

• Denial prevention isn’t one team’s job. Create feedback loops between clinical, financial, and operational teams to share insights and drive systemwide improvements.