In the world of revenue cycle management (RCM), denial management is one of the most time-consuming and frustrating parts of the billing process.
Every biller knows the drill — spend 20 minutes (or more) on hold with the payer, navigate endless phone trees, finally reach a representative, and then dig through the details to figure out why a claim was denied or why it still hasn’t been paid.
With Populate’s AI-based denial management system, powered by our AI agent Rachel, we’ve automated this process end-to-end, saving billers countless hours every week while improving accuracy, transparency, and follow-through.
Rachel: The AI Biller Who Never Waits on Hold
Rachel doesn’t just read denial codes. She proactively identifies denials every day and flags claims that haven’t been paid in the last 30 days. Then, just like your most experienced biller, she calls the payer directly — on behalf of your team — to get the answers you need.
Here’s what makes Rachel different:
• Knows exactly who to call. For the majority of payers, Rachel dials the direct line to reach a human, bypassing automated dead-ends.
• Talks like an expert biller. Rachel’s conversations mirror the skill and nuance of experienced RCM staff — asking the right follow-up questions, clarifying vague answers, and ensuring the denial reason is documented in full.
• Delivers actionable insights into your workflow. The outcomes of every call go straight into the claim notes in Populate — no manual re-entry required.
Real Denial Reasons, Captured Automatically
Rachel’s conversations with payer representatives yield specific, actionable denial reasons. Here are a few real examples our system has recorded:
Non-covered Service Under Patient’s Plan
“The claim was denied due to it being non-covered under the patient’s HMO DSNP Plan. No further appeal instructions provided.”
Out-of-Network Provider
“Service rendered by an out-of-network provider. Appeal must be filed with medical records within 180 days of denial.”
Duplicate Claim
“Denied as a duplicate. Must submit a corrected claim with EOB and use frequency code 7 to avoid repeat denial.”
Same-Day Visit Rule + Diagnosis Mismatch
“Only one visit by the same doctor on the same day is covered. Also, the diagnosis code does not support the billed procedure.”
Global Surgical Fee Restriction
“Procedure code 99204 is not separately reimbursable when billed with procedure 29540. Submit a reconsideration request.”
Bundled Neuropsych Testing Codes
“Reimbursement policy does not allow codes 96132 and 96133 as separate charges. Submit corrected claim with modifier.”
Tagging: The Secret to Scalable Denial Workflows
Rachel doesn’t work in isolation. She’s part of a tag-driven workflow that makes managing denials and unpaid claims fast and organized.
Here’s how:
1. Billers mark claims for Rachel — Any claim can be tagged as “Rachel to review”. These are automatically added to Rachel’s call list.
2. Rachel updates the claim — Once Rachel speaks with the payer and documents the outcome, she adds the “Rachel review completed” tag.
3. Filter and act instantly — Billers can filter claims by tag to see exactly what’s been reviewed, what’s still pending, and where to prioritize follow-ups.
The result? A clear, searchable, and trackable denial management pipeline — with no digging through individual claim records.
The Bigger Picture: Freeing Billers to Do Higher-Value Work
When you take away the repetitive, low-value parts of denial management — sitting on hold, tracking down phone numbers, retyping notes — you give your billers the time and space to focus on preventing denials in the first place.
That means:
• Reviewing documentation and coding accuracy
• Educating providers on high-risk billing patterns
• Working on appeals that require human judgment and nuance
• Analyzing trends to drive down denial rates over time
Populate’s AI + tagging system doesn’t replace billers — it elevates them. It lets them work at the top of their license, doing the kind of proactive, value-added work that actually moves the needle for practice revenue.
Bottom Line
If your denial management process still relies on manual phone calls and sticky notes, you’re leaving both money and time on the table.
With Rachel handling payer calls and Populate’s Tagging keeping your workflow clean and actionable, denial management becomes:
• Faster
• More accurate
• Less frustrating
Your billers stop wasting 20 minutes on hold and start spending more time solving problems. And in the end, that means more revenue, happier staff, and a more efficient practice.
Zubair Noman
CTO, Populate
Learn more: https://youtu.be/UhVcb3OBn7Q
Try it out: https://populateemr.com/rachel/