Denied claims traced back to one unchecked date
A hospital revenue cycle team whose denial rate was driven by authorisations that had expired before the date of service.
Who they are.
A hospital revenue cycle team. Its denial rate was not driven by clinical disputes but by administrative ones — and the largest single cause was an authorisation that had expired before the date of service.
Anonymised at the client’s request. Client names are never disclosed without written permission.
What had to be solved.
Authorisation validity was confirmed at scheduling and then never re-checked. A procedure moved by two weeks silently invalidated its authorisation, and the denial was worked after the fact, one appeal at a time.
What success looked like.
- Check authorisation validity against the actual date of service
- Catch an expired authorisation before the claim is submitted
- Stop working denials that were predictable
What Ceertia does here.
Six use cases across the main service lines. Each reads the date of service from the record and checks the authorisation against that date specifically, citing both the authorisation zone and the service date it was compared to.
The insurance authorisation must be valid on the date of service — not on the date it was requested.
How it runs, step by step.
The file arrives with its documents, in any format, from whoever sends it.
Every page is identified and mapped against the expected document list. Missing documents, duplicates and out-of-scope pages are flagged on receipt.
Each rule asks the file a question and answers it directly on the documents, with page, zone and source text attached to the verdict.
The team approves, requests a fix, or rejects. No file is approved or rejected automatically.
What changed.
Denials fell by roughly a third, almost entirely from this one class of error. The appeals team stopped spending its capacity on rejections that could have been prevented at submission.
- Authorisation validity was confirmed at scheduling, then never re-checked.
- A procedure moved by two weeks silently invalidated its authorisation.
- Denials were worked after the fact, one appeal at a time.
- Validity is checked against the actual date of service, on every claim.
- An expired authorisation is flagged before the claim is submitted.
- Each verdict cites the authorisation zone and the service date it was compared to.
Anonymised case. Client names are never disclosed without written permission. Figures describe the file volumes and checks in this scenario.
Other files, same engine.
A hospital admissions office assembling patient files from referrals, payers and patients themselves, where one missing page delayed a scheduled procedure.
Read the case → HealthcareEvery implanted device traceable to a valid certificateA hospital procurement and compliance function required to prove, per device, that documentation was complete and current at the time of use.
Read the case →See it run on your own files.
Bring one real file to a 30-minute demo. Watch the verification run, evidence on screen.