Case study · Denial Avoidance
A National Reference Lab put $2.89M in denied revenue back in reach.
A National Reference Laboratory
A National Reference Laboratory
“Health Universe helps us protect revenue while keeping the clinical story behind each case front and center.”
— President & Chief Medical Officer
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Revenue
Revenue identified across 77,302 denied claims
Reach
Of patients' care-network records located
Prevention
Avoidable-denial signal — cleared the 30% program bar
The challenge
Losing revenue to denials for missing medical necessity.
Specimens arrived with a code and no clinical story, claims were denied, and denied claims were written off rather than appealed.
The frustrating part: in most cases the diagnosis that justified the test already existed — it just lived in records the lab never received.
What they needed
01
To identify exactly what diagnosis or documentation each denied claim was missing, claim by claim
02
Access to clinical context held outside the lab's own systems, across the patient's care network
03
A workflow that kept billing and coding in control, with human sign-off before submission
04
Ideally, a way to prevent the denial at the point of order rather than chase it after the fact
The difference
Why they chose Health Universe
The lab's own systems — and any billing tool on top of them — can only re-work what's already on the claim. Only Health Universe can reach a diagnosis recorded at another site of care.
Retrieves records the lab never sees
Clinical context pulled from across the patient's care network.
Pinpoints exactly what's missing
The specific diagnosis or documentation each denied claim needs, claim by claim.
Moves the fix upstream
Evidence retrieval shifts to the point of order, so the claim is documented correctly before the specimen is collected.
In practice
The Approach
The lab ran its denial population through Health Universe, and the platform reached across the care network to retrieve the records behind each denied claim. Agents then isolated the specific diagnosis each was missing, and drafted appeals routed by confidence — so billing and coding signed off before anything was submitted. The same capability then moved upstream, to the point of order.
Before Health Universe
After Health Universe
Missing diagnosis
Lost — sat in records the lab never received
Retrieved from across the patient's care network
Denied claims
Written off, rarely appealed
Triaged, evidenced, and appealed
Appeal creation
Manual or skipped
Drafted by the platform, approved by the team
Point of intervention
After the denial
At the point of order, before collection
Team's role
Chasing denials reactively
Reviewing and signing off on defensible appeals
Missing diagnosis
Before
Lost — sat in records the lab never received
After
Retrieved from across the patient's care network
Denied claims
Before
Written off, rarely appealed
After
Triaged, evidenced, and appealed
Appeal creation
Before
Manual or skipped
After
Drafted by the platform, approved by the team
Point of intervention
Before
After the denial
After
At the point of order, before collection
Team's role
Before
Chasing denials reactively
After
Reviewing and signing off on defensible appeals
Proof
The Results
Denial management stopped being a recovery problem — it became a prevention one.
The clinical context that justified each test existed all along. Health Universe reached it, evidenced every denial, and moved the fix upstream — to the point of order, before the specimen is collected.
Revenue
Revenue identified across 77,302 denied claims
Reach
Of patients' care-network records located
Prevention
Avoidable-denial signal — cleared the 30% program bar
Denial Avoidance
“Health Universe gives revenue cycle teams the clinical context they need to identify supportable claims, reduce avoidable write-offs, and move medical necessity review upstream.”
VP of RCM · A National Reference Laboratory
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