The Denial Management Solution That Unifies Payers & Providers
The industry’s approach to denials is broken, pitting payers and providers against one another in a never-ending game of tug of war. TREND ditched this approach and replaced it with collaboration; creating an equitable denial management solution and claims resolution for a healthier healthcare system.
Payer considerations
Denials Aren’t Just a Challenge for Providers, They’re a Burden on Payers Too
Denials burden healthcare payers by increasing administrative workload, slowing claims processing, and raising operational costs. Managing denied claims, appeals, and disputes diverts resources from strategic activities and delays provider reimbursements, straining relationships. To avoid inefficiencies and financial losses, payers need solutions to streamline denial management, improve claim accuracy, and reduce unnecessary denials.
Payer Challenges
- Increased Administrative Burden
- Higher Operational Costs
- Delayed Claims Adjudication
- Provider Dissatisfaction
- Financial Losses
Reduce Denials by Ensuring That Claims Are Accurate With AI-Driven Medical Record Review Technology for Payers
The CAVO® technology platform streamlines the medical record review process at both the functional and enterprise level. Using deep clinical and coding expertise in conjunction with NLP and ML as the backbone of our AI-driven use case deployment, CAVO® facilitates a 10X faster claim or record review, significantly improves the financial outcome per FTE, and accelerates ongoing process improvement. Learn more about our payer solutions below.
Use Cases
DRG Reviews
IB Reviews
Medical Necessity
Provider Appeals Management
Built-In EMR API Access
Simplify the clinical documentation and record retrieval process for claims reviews with CAVO® Connect. With provider support, CAVO Connect enables health plan EMR access using FHIR to real-time data in medical records, itemized bills, and additional clinical documentation—while eliminating both provider and your plan’s costly administrative burden.
750M
saved in claim expenses since CAVO’s inception
100M
insured members supported across commercial, medicare advantage, and managed Medicaid markets
350%
average user productivity increase within 90 days of implementation
32%
average reduction in administrative expenses
Provider considerations
Denial Management for Healthcare Providers
Clinical denial backlogs happen, but we’re here to help. TREND Health Partners’ flexible model allows us to supplement your denial management team when, where, and as you need it.TREND has a 20% higher overturn success rate than the industry benchmark
Choosing the right denial management partner can help your organization reduce time to revenue and decrease the cost to collect. With best-in-class technology and deep clinical experience, TREND Health Partners can not only help manage your organization’s current denials but serve as a partner to strategically prevent your denials, as well.Why Use TREND for Denial Management?
Dedicated Client Experience Manager
100% US-Based Team
Customized Solutions
Cutting-Edge Technology
Powered by CAVO
ABOUT CAVO®
TREND Health Partners’ CAVO platform intakes and extracts data from medical records while utilizing a proprietary search functionality that allows pertinent data to be extracted at the click of a button without requiring a cumbersome visual review. CAVO supports coders, nurses, and physicians in searching for documents supporting the diagnosis sequencing if the DRG assigned is consistent with the documentation and treatment.
Platform Features
Pre-defined Searches
CAVO offers pre-defined searches to help you find what you’re looking for faster.
Open API for Reporting
CAVO augments current technology already in place within your organization.
Robust Appeal History
Payer Policies
Payer policies and medical records are accessible within the CAVO platform, so all of the information is displayed on one screen.
Letter Templates & Snippets
CAVO contains saved appeal letter templates connected to the EMR, which will automatically populate with demographic information, reducing the risk of human error.
Delivering Better Outcomes Through the First Collaborative Model for Denial Management & Claims Adjudication
Providers Reduce Denied Claims
Payers Adjudicate Claims More Efficiently
Everyone Saves Time & Money
We’ve Been Looking At Denials All Wrong
“Denials management” is an artifact of the legacy paradigm between payers and providers. It has come to represent an adversarial dynamic, with each side deploying ever-escalating resources to secure hypothetical dollars. When, in reality, the majority of “denials” are actually a request for additional information in one form or another. We hope to usher in a new TREND, one where claim denials are no longer viewed through an adversarial lens.
The Problem
Denials Are Necessary,
But Applied/Managed Inefficiently
Denials help ensure claims meet payer guidelines and prevent improper payments, but they often create new challenges due to inconsistent documentation, communication gaps, and complex requirements, and lack of payer/provider collaboration.
Denials financially strain both payers and providers.
Denials increase administrative costs associated with reprocessing, appeals, and corrections, while delaying reimbursements for providers and prolonging claim resolution for payers. This inefficiency ties up resources and cash flow, impacting both parties’ financial stability.
Denials worsen the administrative burden for all.
Denials require additional time and resources to investigate, correct, and resubmit claims, as well as to handle appeals and follow-up communication. This repetitive work increases operational complexity, slowing down the revenue cycle and straining both payers and providers.
Denials lead to delays in reimbursement.
Denials create delays in receiving payments, which can disrupt financial planning and impact the ability for providers to invest in patient care. And extended timeframes for resolving denials increase claims processing costs and administrative complexity.
Without working together, nobody sees the full picture.
Lack of clear communication from payers about denial reasons or requirements makes it difficult for providers to address their root causes, leading to repeat errors. And incomplete or inaccurate information in claims submissions forces payers to deny claims, causing inefficiencies in adjudication.
Mismanaged denials put payers and providers at risk.
Inaccurate or non-compliant claim submissions put providers at risk for audits and penalties, while failure to handle denials appropriately can lead to regulatory scrutiny and potential penalties for payers.
Rampant denials damage the patient experience.
Denied claims create confusion and frustration for patients, who may face unexpected bills, delays in treatment, or interruptions in care; damaging the reputation of payers and providers alike.
The Unified Approach to Denial Management
TREND operates as an extension of both payer and provider teams, automating the assimilation data to accelerate the claims process. With root cause reporting and analytics, the denials process is optimized to reduce friction and overhead for both parties.
Ingest Data
Intelligence
Clarity
Resolve
Report & Prevent
No Sides, Just Solutions.
It's Better in the Middle.
Serving as a mutual partner to both payers and providers creates significant advantages as measured in claims payment rates, denial overturn rates and overall claim resolution speed. Both sides benefit from cleaner claims and faster overall processing.
Payers and providers partnered with TREND both spend less money and fewer resources on resolving claims. Trend has visibility to the rules and procedures and on both sides, eliminating the struggles of the old way.
TREND’s Appeals Are Impartial, Thorough, And Trusted
20%
higher than the industry average
TREND has a 20% higher overturn success rate than the industry benchmark.
100%
Unbiased
TREND doesn’t play for “team payer” or “team provider” – we play for Team Healthcare.
Combat the Most Common Cause of Denials
Validating Medical Necessity
Combat Prior Authorization Denials
DRG and Clinical Validation
The TREND Difference
TREND’s approach to denial management is an outlier in the healthcare industry. Instead of fighting for one side or the other, we fight alongside both payers and providers to defeat ambiguity, inefficiency, and waste.
Clinical Expertise
Industry-Leading Technology
Strategic Partnerships
Comprehensive Defense
Precision Documentation
Root Cause Prevention
TECHNOLOGY
Powered By CAVO®
Without CAVO, nurses would spend hours sifting through medical records for key information that drives decisions, while constantly comparing it to changing payer policies. With CAVO, we get to our relevant decision data faster, so we can drive more consistent and higher quality appeal responses for our clients.
“The quality of the denial letters are stellar, citing the most up-to-date evidence-based literature. The feedback that the TREND team provides serves as a clinician education opportunity so that history does not repeat itself… I find their results effective and their costs reasonable considering their expertise in their field.”
– Director of Case Management, Regional Health System