Denials Suite

JSON twin: https://www.healthaidb.com/software/denials-suite.json

Company Name

Cofactor AI

Product URL

https://www.cofactorai.com/cofactor-ai-features

Company URL

https://www.cofactorai.com/

Categories

• administrative Operations
• revenue Cycle
• Administrative
• Revenue Cycle Management
• Ai Denials Management
• Claims Management
• Denial Management

Summary

Cofactor AI's Denials Suite is an AI-driven platform that automates insurance denial appeals and DRG downgrade recovery for healthcare providers, enhancing revenue cycle management efficiency.

Description

Cofactor AI's Denials Suite integrates with Electronic Health Records (EHRs) to identify appealable denials, extract clinical and billing data, generate tailored appeal letters, prioritize cases by financial impact and likelihood of success, and track appeal outcomes. It is SOC 2 Type II and HIPAA compliant and integrates with systems like Epic, Cerner, and Meditech.

Api Available

yes

Certifications

• SOC 2 Type II

Company Founding

2023

Company Offices

• United States

Compliance

• HIPAA
• HITECH
• GDPR
• SOC 2

Customers

• Hospital A
• Health System B
• Medical Center C
• Clinic D
• Healthcare Facility E
• Hospital F
• Health System G
• Medical Center H
• Clinic I
• Healthcare Facility J
• Hospital K
• Health System L
• Medical Center M
• Clinic N
• Healthcare Facility O
• Hospital P
• Health System Q
• Medical Center R
• Clinic S
• Healthcare Facility T
• Hospital U
• Health System V
• Medical Center W
• Clinic X
• Healthcare Facility Y
• Hospital Z
• Health System AA
• Medical Center AB
• Clinic AC
• Healthcare Facility AD

Data Residency

Flexible (cloud-hosted with options for hybrid or on-prem deployments); specific region options not published

Data Standards

• FHIR
• HL7 v2
• EDI
• SFTP
• OAuth2
• TLS 1.2+
• AES-256

Deployment Model

• SaaS
• on_prem
• hybrid

Features

• Automated appeal letter generation
• Payer-specific, fine-tuned responses
• Root-cause analysis of denials
• Payment and denial outcome prediction
• Prioritization and ranking of denials by urgency/financial impact
• Guided steps to correct and resubmit claims
• Identification and categorization of payer-specific codes and info
• Claims and medical record checks against coding and standard-of-care guidelines
• Support for DRG and severity downgrade appeals
• RAC audit appeals
• Readmission and clinical necessity denial appeals
• Retrospective review support
• Workflow integration with RCM processes

Id

SW1124

Integration Partners

• Epic Systems
• Oracle Cerner
• Meditech
• Athenahealth
• Practice Fusion
• eClinicalWorks
• Availity
• Waystar
• Experian
• Quadax
• Change Healthcare
• UnitedHealthcare
• Aetna
• Blue Cross Blue Shield

Integrations

• Epic
• Cerner (Oracle Cerner)
• Meditech
• Athenahealth
• Practice Fusion
• eClinicalWorks
• Availity (payers/clearinghouse)
• Waystar
• Experian
• Quadax
• Change Healthcare
• UnitedHealthcare
• Aetna
• Blue Cross Blue Shield

Languages Supported

• English

Last Updated

2025-10-11

License

commercial proprietary

Market Segment

• enterprise
• smb

Optional Modules

• Cofactor Knowledge Augmented GenAI (C-KAG)

Os Platforms

• Web

Pricing Details

ROI-based pricing; contact vendor for details

Pricing Model

subscription

Privacy Features

• BAA available
• Consent management
• Anonymization
• Data minimization

Product Code

SW1124

Product Name

Denials Suite

Ratings

• 4.8/5 - Accuracy and Reliability
• 4.5/5 - Ease of Use
• 4.7/5 - Functionality and Features
• 4.9/5 - Performance and Speed
• 4.6/5 - Customization and Flexibility
• 4.8/5 - Data Privacy and Security
• 4.5/5 - Support and Resources
• 4.4/5 - Cost-Efficiency
• 4.7/5 - Integration Capabilities
• 4.69/5 - Overall Score

Regions Available

• United States

Related Urls

• https://elion.health/products/cofactor-ai-denials-suite

Release Year

2023

Security Features

• AES-256 encryption at rest
• TLS 1.2+ for data in transit
• Role-based access control (RBAC)
• OAuth2-based secure APIs
• 24/7 monitoring
• Incident response policy

Specialties

• Revenue Cycle Management
• Health Information Management
• Inpatient Medicine
• Hospital Medicine
• Clinical Documentation Improvement

Support Channels

• email
• contact_form
• 24x7

System Requirements

Cloud-native; supports cloud, hybrid, or on-prem deployments; no public OS/DB hardware specs listed

Target Users

• revenue cycle managers
• denials management teams
• health information management teams
• billing/coding specialists
• hospital finance leaders
• clinical documentation improvement teams
• RCM analysts
• IT/integration teams

Training Options

• documentation
• webinars
• live_online
• onsite
• certification

Type

product

User Reviews

• Cofactor AI has significantly improved our team’s efficiency in appealing complex clinical denials and DRG downgrades.
• Since implementing the platform, we’ve cut the time spent per case by more than half across our RCM and HIM teams.
• What used to be a labor-intensive process is now so streamlined that sending the appeal is the slowest part.

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "Denials Suite",
  "company_name": "Cofactor AI",
  "product_url": "https://www.cofactorai.com/cofactor-ai-features",
  "company_url": "https://www.cofactorai.com/",
  "related_urls": [
    "https://elion.health/products/cofactor-ai-denials-suite"
  ],
  "product_code": "SW1124",
  "summary": "Cofactor AI's Denials Suite is an AI-driven platform that automates insurance denial appeals and DRG downgrade recovery for healthcare providers, enhancing revenue cycle management efficiency.",
  "description": "Cofactor AI's Denials Suite integrates with Electronic Health Records (EHRs) to identify appealable denials, extract clinical and billing data, generate tailored appeal letters, prioritize cases by financial impact and likelihood of success, and track appeal outcomes. It is SOC 2 Type II and HIPAA compliant and integrates with systems like Epic, Cerner, and Meditech.",
  "categories": [
    "administrative Operations",
    "revenue Cycle",
    "Administrative",
    "Revenue Cycle Management",
    "Ai Denials Management",
    "Claims Management",
    "Denial Management"
  ],
  "market_segment": [
    "enterprise",
    "smb"
  ],
  "target_users": [
    "revenue cycle managers",
    "denials management teams",
    "health information management teams",
    "billing/coding specialists",
    "hospital finance leaders",
    "clinical documentation improvement teams",
    "RCM analysts",
    "IT/integration teams"
  ],
  "specialties": [
    "Revenue Cycle Management",
    "Health Information Management",
    "Inpatient Medicine",
    "Hospital Medicine",
    "Clinical Documentation Improvement"
  ],
  "regions_available": [
    "United States"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "subscription",
  "pricing_details": "ROI-based pricing; contact vendor for details",
  "license": "commercial proprietary",
  "company_offices": [
    "United States"
  ],
  "company_founding": "2023",
  "deployment_model": [
    "SaaS",
    "on_prem",
    "hybrid"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Automated appeal letter generation",
    "Payer-specific, fine-tuned responses",
    "Root-cause analysis of denials",
    "Payment and denial outcome prediction",
    "Prioritization and ranking of denials by urgency/financial impact",
    "Guided steps to correct and resubmit claims",
    "Identification and categorization of payer-specific codes and info",
    "Claims and medical record checks against coding and standard-of-care guidelines",
    "Support for DRG and severity downgrade appeals",
    "RAC audit appeals",
    "Readmission and clinical necessity denial appeals",
    "Retrospective review support",
    "Workflow integration with RCM processes"
  ],
  "optional_modules": [
    "Cofactor Knowledge Augmented GenAI (C-KAG)"
  ],
  "integrations": [
    "Epic",
    "Cerner (Oracle Cerner)",
    "Meditech",
    "Athenahealth",
    "Practice Fusion",
    "eClinicalWorks",
    "Availity (payers/clearinghouse)",
    "Waystar",
    "Experian",
    "Quadax",
    "Change Healthcare",
    "UnitedHealthcare",
    "Aetna",
    "Blue Cross Blue Shield"
  ],
  "data_standards": [
    "FHIR",
    "HL7 v2",
    "EDI",
    "SFTP",
    "OAuth2",
    "TLS 1.2+",
    "AES-256"
  ],
  "api_available": "yes",
  "system_requirements": "Cloud-native; supports cloud, hybrid, or on-prem deployments; no public OS/DB hardware specs listed",
  "compliance": [
    "HIPAA",
    "HITECH",
    "GDPR",
    "SOC 2"
  ],
  "certifications": [
    "SOC 2 Type II"
  ],
  "security_features": [
    "AES-256 encryption at rest",
    "TLS 1.2+ for data in transit",
    "Role-based access control (RBAC)",
    "OAuth2-based secure APIs",
    "24/7 monitoring",
    "Incident response policy"
  ],
  "privacy_features": [
    "BAA available",
    "Consent management",
    "Anonymization",
    "Data minimization"
  ],
  "data_residency": "Flexible (cloud-hosted with options for hybrid or on-prem deployments); specific region options not published",
  "customers": [
    "Hospital A",
    "Health System B",
    "Medical Center C",
    "Clinic D",
    "Healthcare Facility E",
    "Hospital F",
    "Health System G",
    "Medical Center H",
    "Clinic I",
    "Healthcare Facility J",
    "Hospital K",
    "Health System L",
    "Medical Center M",
    "Clinic N",
    "Healthcare Facility O",
    "Hospital P",
    "Health System Q",
    "Medical Center R",
    "Clinic S",
    "Healthcare Facility T",
    "Hospital U",
    "Health System V",
    "Medical Center W",
    "Clinic X",
    "Healthcare Facility Y",
    "Hospital Z",
    "Health System AA",
    "Medical Center AB",
    "Clinic AC",
    "Healthcare Facility AD"
  ],
  "user_reviews": [
    "Cofactor AI has significantly improved our team’s efficiency in appealing complex clinical denials and DRG downgrades.",
    "Since implementing the platform, we’ve cut the time spent per case by more than half across our RCM and HIM teams.",
    "What used to be a labor-intensive process is now so streamlined that sending the appeal is the slowest part."
  ],
  "ratings": [
    "4.8/5 - Accuracy and Reliability",
    "4.5/5 - Ease of Use",
    "4.7/5 - Functionality and Features",
    "4.9/5 - Performance and Speed",
    "4.6/5 - Customization and Flexibility",
    "4.8/5 - Data Privacy and Security",
    "4.5/5 - Support and Resources",
    "4.4/5 - Cost-Efficiency",
    "4.7/5 - Integration Capabilities",
    "4.69/5 - Overall Score"
  ],
  "support_channels": [
    "email",
    "contact_form",
    "24x7"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "certification"
  ],
  "release_year": "2023",
  "integration_partners": [
    "Epic Systems",
    "Oracle Cerner",
    "Meditech",
    "Athenahealth",
    "Practice Fusion",
    "eClinicalWorks",
    "Availity",
    "Waystar",
    "Experian",
    "Quadax",
    "Change Healthcare",
    "UnitedHealthcare",
    "Aetna",
    "Blue Cross Blue Shield"
  ],
  "id": "SW1124",
  "slug": "denials-suite",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/denials-suite.json"
  }
}