HeronIntelligence
Trained on 14,820 historical claims · Updated daily
Model v2.4 · 83.1% accuracy
Real-Time Denial Predictor
Payer
CPT Code
Diagnosis
AI Appeal Letter Generator
Claim
Select a claim and click “Generate Letter” to draft an AI-powered appeal using claim history and clinical guidelines...
Denial Pattern Analysis
AI-detected trends across payer × reason combinations
Updated 2h ago
UnitedHealthcare·Medical Necessity
+18%critical
UnitedHealthcare medical necessity denials increased 18% this quarter. Review clinical documentation standards for this payer.
18 claims affected
Aetna·Medical Necessity
+16%critical
Aetna medical necessity denials increased 16% this quarter. Review clinical documentation standards for this payer.
9 claims affected
Cigna·Medical Necessity
+11%critical
Cigna medical necessity denials increased 11% this quarter. Review clinical documentation standards for this payer.
9 claims affected
BCBS·Medical Necessity
+19%critical
BCBS medical necessity denials increased 19% this quarter. Review clinical documentation standards for this payer.
5 claims affected
Medicare·Medical Necessity
+14%critical
Medicare medical necessity denials increased 14% this quarter. Review clinical documentation standards for this payer.
5 claims affected
Network Benchmark
Compared against 127 facilities
Medicare+9% above avg
Top 25%: 3%Avg: 5%You: 14%
Attach clinical notes and imaging upfront
Aetna+5% above avg
Top 25%: 3%Avg: 7%You: 12%
Verify prior auth requirements before submission
Humana+5% above avg
Top 25%: 3%Avg: 7%You: 12%
Verify prior auth requirements before submission
UnitedHealthcare+4% above avg
Top 25%: 4%Avg: 7%You: 11%
Verify prior auth requirements before submission
Denial Rate by Payer
Medicare
14%
Aetna
12%
Humana
12%
UnitedHealthcare
11%
Cigna
10%
BCBS
9%
Medicaid
6%
Top Denial Reasons · Last 90 Days
Medical Necessity
53
Pre-Auth Missing
25
Bundling/Coding Error
17
Missing Information
17
Not Covered
10