NewERA reconciliation now reports parsed claims, denied exposure, and data-quality issues.
Revenue Cycle Operating System·Deadline Authority · Payer Rules · Governed AI

The operating system for the
hospital revenue cycle.

Eligibility, prior authorization, charge capture, claims, remittance, payment integrity, patient payments, denials and recovery — one governed system of record, with money lineage from charge to cash.

Request an enterprise demoExplore the platform
No black-box AI — every action is human-reviewedHIPAA-aligned architecture with tenant isolationFHIR R4 connector foundations for Epic, Oracle Health, athenahealth
Eligibility through recovery — one governed system of record
Payer workflow coverage
Familiar payer context without claiming payer partnership
Tenant isolationHuman authorityAudit historyPHI-safe alerts
Major payer workflowsCase-level evidenceBuilt for recovery teams

Organize denials across payer contextswith one recovery queue.

Commercial, Medicare, Medicaid, and Tricare workflows can be tracked in one place while your team reviews every appeal before submission.

835
01
ERA intake
R4
02
FHIR foundation
Human
03
Review-first actions
Source
04
Observed outcomes

Common payer workflows

Example payer contexts · hover any row to pause

Example payer contexts · review-first workflow
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Cigna logoCignaCommercial
UnitedHealth logoUnitedHealthCommercial
BCBS Texas logoBCBS TexasRegional
Humana logoHumanaCommercial
Anthem logoAnthemCommercial
Molina logoMolinaMedicaid
Kaiser logoKaiserRegional
Tricare logoTricareGovernment
Medicare logoMedicareGovernment
Medicaid logoMedicaidGovernment
Oscar logoOscarCommercial
Aetna logoAetnaCommercial
Cigna logoCignaCommercial
UnitedHealth logoUnitedHealthCommercial
BCBS Texas logoBCBS TexasRegional
Humana logoHumanaCommercial
Anthem logoAnthemCommercial
Molina logoMolinaMedicaid
Kaiser logoKaiserRegional
Tricare logoTricareGovernment
Medicare logoMedicareGovernment
Medicaid logoMedicaidGovernment
Oscar logoOscarCommercial
Humana logoHumanaCommercial
Anthem logoAnthemCommercial
Molina logoMolinaMedicaid
Kaiser logoKaiserRegional
Tricare logoTricareGovernment
Medicare logoMedicareGovernment
Medicaid logoMedicaidGovernment
Oscar logoOscarCommercial
Aetna logoAetnaCommercial
Cigna logoCignaCommercial
UnitedHealth logoUnitedHealthCommercial
BCBS Texas logoBCBS TexasRegional
Humana logoHumanaCommercial
Anthem logoAnthemCommercial
Molina logoMolinaMedicaid
Kaiser logoKaiserRegional
Tricare logoTricareGovernment
Medicare logoMedicareGovernment
Medicaid logoMedicaidGovernment
Oscar logoOscarCommercial
Aetna logoAetnaCommercial
Cigna logoCignaCommercial
UnitedHealth logoUnitedHealthCommercial
BCBS Texas logoBCBS TexasRegional
Tricare logoTricareGovernment
Medicare logoMedicareGovernment
Medicaid logoMedicaidGovernment
Oscar logoOscarCommercial
Aetna logoAetnaCommercial
Cigna logoCignaCommercial
UnitedHealth logoUnitedHealthCommercial
BCBS Texas logoBCBS TexasRegional
Humana logoHumanaCommercial
Anthem logoAnthemCommercial
Molina logoMolinaMedicaid
Kaiser logoKaiserRegional
Tricare logoTricareGovernment
Medicare logoMedicareGovernment
Medicaid logoMedicaidGovernment
Oscar logoOscarCommercial
Aetna logoAetnaCommercial
Cigna logoCignaCommercial
UnitedHealth logoUnitedHealthCommercial
BCBS Texas logoBCBS TexasRegional
Humana logoHumanaCommercial
Anthem logoAnthemCommercial
Molina logoMolinaMedicaid
Kaiser logoKaiserRegional
Tenant-scoped accessHuman-reviewed workflowsAppend-only operational historySigned document accessPHI-safe notification metadataPayer-aware case trackingTenant-scoped accessHuman-reviewed workflowsAppend-only operational historySigned document accessPHI-safe notification metadataPayer-aware case tracking
Platform overview

One platform for the entire
revenue cycle.

Eligibility, prior authorization, charge capture, claims, remittance, payment integrity, denials and recovery — one governed system of record, with the money lineage from charge to cash intact.

denialos.io / platform
Illustrative workspace
Eligibility
Real-time coverage
Denials
Deadline-governed
Recovery
Charge-to-cash lineage
RCM LifecycleActive
Eligibility
Prior Auth
Claims
Denials
Recovery
EHR Connections
EpicOracle HealthathenahealthGeneric FHIR
AI Governance
Every AI-assisted decision is flagged for human review before it affects a claim, payer, or patient record.
Human review required
Revenue at risk
$2.4M
75% in-flight
Payer intelligence
UHC94% win rate
Aetna91% win rate
BCBS88% win rate
FHIR R4
EHR integrations supported
79+
Platform capability domains
AI
Governed with human review
100%
Payer interaction audit logging
The platform

Everything enterprise RCM
demands — in one platform.

From point-of-service clearance to post-payment recovery, DenialOS runs the full revenue cycle on one governed record — eligibility, prior authorization, charge capture, claims, remittance, payment integrity, denials and recovery — with FHIR R4 connector foundations for Epic, Oracle Health and athenahealth.

Denials worked on a governed deadline clock.

DenialOS classifies every denial against payer rules, computes the canonical appeal deadline, and drafts the response from payer policy, clinical references and your own outcome history. Every draft is flagged for human review before it goes out.

RE: Denial — illustrative appeal draft
Draft prepared from payer policy, denial facts, clinical guidelines, and your own appeal outcome history. Missing evidence flagged for human review.
Sources: payer policy · clinical evidence · outcomes history · denial facts
Human review required before submission

Eligibility & financial clearance

Real-time coverage verification and charge validation before claims are submitted — stopping denials at the point of service.

EpicOracle Healthathenahealth

Payer intelligence & change radar

Track payer behavior, denial patterns, and policy changes in real time. Know which payers are tightening rules before they hit your inbox.

Payer behaviorPolicy changesDenial codesAppeal outcomes

Revenue intelligence & simulation.

See real revenue exposure by payer, denial type and deadline. Run what-if simulations before committing to a recovery strategy. CFO-ready dashboards built on observed outcomes.

CFO-ready dashboards
Revenue recovery trend
JanJunDec

AI you can defend to compliance.

Every AI-assisted classification, extraction, and drafting action is logged, flagged for human review, and auditable. DenialOS was built for HIPAA-aligned environments — not retrofitted for them.

AI decisions logged for audit
Human review gates on all actions
PHI never leaves tenant scope
Governance controls configurable

Operational observability.

Monitor every workflow, worker, ingestion job, and integration health from a single dashboard. Replay failed jobs, track deadline risk, and see your human attention queue in real time.

Backend ops dashboard

Payer interactions tracked end-to-end.

Log every call, email, and portal action with payers. Build threads tied directly to the case, denial, and outcome record — compliance-ready audit trails your team can actually use.

FHIR R4 EHR integration.

Native FHIR R4 adapters for Epic, Oracle Health, and athenahealth — plus SMART Backend Services for programmatic payer authorization. No portal scraping. No flat-file feeds.

EpicOracle HealthathenahealthSMART contracts
Full RCM lifecycle

From eligibility check to
revenue recovered — in five steps.

DenialOS covers every phase of the revenue cycle with a single linked record, one audit trail, and governed AI at every decision point.

See a full case walkthrough
01

Connect your systems

Configure FHIR R4 connector foundations for Epic, Oracle Health, or athenahealth. Set up payer SMART Backend Services contracts. Live tenant connectivity is unvalidated until your integration is stood up.

02

Eligibility, clearance, and intake — in one pass

Verify patient coverage at the point of service. Run charge coding and financial clearance checks. When a denial arrives via 835, X12, HL7, or manual upload — it is parsed, matched, and pre-classified automatically.

03

AI drafts the response. Humans approve it.

DenialOS drafts evidence-aware appeal language from payer-specific rules, clinical policy references and your own outcome history. Every draft is flagged for human review — no AI action goes unchallenged.

04

Payer interactions logged. Outcomes observed.

Every call, email, and follow-up with the payer is tied to the case record. Approved appeals are tracked through resolution. Recovery amounts are recorded as observed data — not estimates.

05

Revenue intelligence for the next cycle

Win-rate analysis, payer intelligence, revenue simulation, and deadline risk dashboards feed your CFO and RCM leadership. DenialOS becomes the evidence base for better decisions every quarter.

For every stakeholder in the revenue cycle

One platform. Different reasons to trust it.

DenialOS is built for hospital systems and enterprise RCM teams who need accountability, compliance, and results — not just another denial queue.

DenialOS

Hospital & health system leadership

See denial accumulation, recovery rates, deadline exposure, and revenue at risk across every payer — in one accountable view built for board reporting.

DenialOS

Revenue cycle management teams

Manage denials from intake through resolution, with AI-assisted drafts, payer intelligence, deadline tracking, and outcome logging — all in one governed workspace.

DenialOS

Health IT & integration engineers

FHIR R4 connector foundations for Epic, Oracle Health, and athenahealth. Configure SMART Backend Services for payer authorization. Monitor integration health from the operational dashboard. Live tenant connectivity is unvalidated.

DenialOS

Finance & CFO

Get CFO-ready revenue intelligence dashboards, revenue simulation, outcome learning, and portfolio-level recovery tracking — all tied to observed data, not forecasts.

DenialOS

Compliance & HIPAA governance teams

Every AI decision is logged, every action is human-reviewable, every record is tenant-scoped. DenialOS was built for healthcare compliance from day one.

Why DenialOS wins

Built different.
Built for health systems.

Waystar
Their weakness:
Expensive enterprise contracts, slow onboarding, no AI governance story
DenialOS advantage:
DenialOS: Deploy in days, governed AI at every step, transparent pricing
R1 RCM
Their weakness:
Human-heavy operations, no payer contract layer, limited transparency
DenialOS advantage:
DenialOS: AI-assisted workflows, SMART Backend Services, full audit trail
FinThrive
Their weakness:
Legacy siloed modules, no real-time payer intelligence
DenialOS advantage:
DenialOS: Unified platform, payer change radar, revenue simulation

Every AI-assisted action in DenialOS must be attributable to a source, reviewable by a named human, and reversible by the team accountable for the claim. Payer intelligence, FHIR R4 connector foundations, and revenue simulation exist to serve that standard — not to route around it.

DO
The DenialOS standard
Product principles · enterprise evaluation
Trust & security

HIPAA-aligned by design,
not by claim.

DenialOS was built for healthcare compliance from day one. Every feature — AI governance, audit logging, tenant isolation, and PHI storage — was designed with HIPAA requirements in mind.

View security overview
HIPAA-aligned architecture
Tenant isolation, role-based access, signed PHI storage, and audit logging built in from the start — not retrofitted.
AI decisions are auditable
Every AI classification, extraction, and drafting action is logged, flagged for human review, and available for compliance audit.
Compliance-ready workflows
Case, draft, approval, and outcome records are structured for OCR-friendly review, HIPAA audit, and regulatory reporting.
Production-configured
Connection profiles, storage keys, and integration settings validated before PHI ever enters the system.
Enterprise pilot

The RCM platform that hospital
systems actually trust.

Schedule a pilot scoping call with our team. We will walk through your EHR integrations, payer mix, denial volume, and compliance requirements — and show you exactly how DenialOS maps to your environment.

Request an enterprise demo Discuss a pilot
Epic · Oracle Health · athenahealthFHIR R4 nativeAI governed with human reviewHIPAA-aligned architecture