Revenue cycle
Every order authorized
before the claim goes out.
EnsureCare checks coverage, authorization, and documentation before the visit, sends missing items to the right person in their existing workflow, and prepares the appeal when a denial still happens.
- 19%
of in-network marketplace claims were denied. Fewer than 1% were appealed.
KFF, 2024 - 95%
of physicians say prior authorization delays care.
AMA Prior Authorization Survey, 2025 - 13 hrs
each week spent on prior authorization per physician and staff.
AMA Prior Authorization Survey, 2025
Where it stalls
Denials start
before the claim.
A claim can fail at many points between the order and payment, including these three.
01
Payer rule missed
Prior auth and coverage rules are checked by hand in payer portals, or not at all.
No prior auth02
Documentation missing
The note the payer requires, such as weeks of physical therapy, is not in the chart.
Denial risk03
Denial never worked
Denied claims wait in a queue, and most are never appealed.
Revenue lost
How it works
From denial risk
to resolved.
Imaging, specialist referrals, and new prescriptions often need prior authorization. Payers require the evidence for each order before they pay.
Denial follow-up
When a denial still happens,
the appeal is ready.
Some denials still get through. EnsureCare matches the denial reason to the evidence in the chart, prepares the appeal in the payer’s format for your team to review, and tracks it to a decision.
How EnsureCare connects to your EHRWhat is different
Denial tools sort the damage.
EnsureCare works before the claim.
| Typical denial management |  EnsureCare | |
|---|---|---|
| When work starts | After the payer denies the claim. | Before the visit, when the order is scheduled. |
| Payer rules | Checked by hand in payer portals. | Checked automatically for every order. |
| Missing documentation | Found after the denial. | Requested from the clinician inside the EHR. |
| Prior auth package | Assembled by staff across systems. | Prepared complete, in the payer’s format. |
| When a denial still happens | Worked if there is time, often never appealed. | The appeal is prepared with the evidence. |
| What counts as done | The claim was submitted. | The claim was paid. |
A submitted claim is activity. A paid claim is closure.
What it is worth
Clean claims,
in your numbers.
Pick what matters to you and adjust
the numbers to match your organization.
Lower denial rate
See how much revenue initial denials put on hold each month, and how much EnsureCare can protect by catching gaps before the claim.
- Denials avoided per month
- 20
- Monthly revenue protected
- $8,000
- Annual revenue protected
- $96,000
Illustrative estimate.
Recover $96,000: Book a DemoBuilt with clinicians, advisors & engineers from
Safety
Your team
stays in control.
No clinical decisions
EnsureCare does not change orders or clinical notes. It asks the clinician for what the payer requires.
Your team handles exceptions
Unusual payer rules, peer-to-peer reviews, and appeals go to your staff, with the evidence attached.
Every step on record
Checks, requests, submissions, and payer decisions are logged in the EHR and auditable.
Pairs well with
When does EnsureCare check a claim?
Before the visit, when the order is scheduled. It checks eligibility, prior auth requirements, and payer documentation rules, so gaps are fixed before the claim exists.
Does it submit prior authorizations?
Yes. EnsureCare assembles the prior auth package with the order, clinical note, and supporting documentation, submits it in the payer’s required format, and tracks the decision.
Does it change clinical documentation?
No. When the payer requires something that is missing, EnsureCare asks the ordering clinician inside the EHR. The clinician decides what to add.
What happens when a claim is still denied?
EnsureCare matches the denial reason to the evidence in the chart and prepares the appeal in the payer’s format. Your billing team reviews it before it is submitted, and EnsureCare tracks it to a decision.
How do you measure results?
Against your own baseline, from your billing and EHR data: initial denial rate, authorizations cleared before the visit, days in accounts receivable, and appeals overturned.
What does CAIR stand for?
CAIR stands for Care Adherence Intelligence & Recovery, EnsureCare’s underlying system for predicting and preventing missed care.
What EHRs does EnsureCare integrate with?
EnsureCare integrates with major EHR systems such as Epic, Oracle Health (Cerner), athenahealth, MEDITECH, eClinicalWorks, and more. If you are not seeing your EHR, please reach out to us.
Is patient data secure with EnsureCare?
EnsureCare implements healthcare-grade security standards. EnsureCare is HIPAA compliant, and SOC 2 compliance is underway. Encryption, role-based access control, and data minimization practices protect sensitive information such as PHI and PII in line with HIPAA requirements.
How long does implementation take?
EnsureCare is deployed in days, and the impact can be seen in weeks. Our engineers collaborate with your IT and compliance teams to establish secure connectivity. Your staff keeps using their familiar workflows without additional software or training.
Integrates with your existing stack
Bring us your denials.
Let’s stop them upstream.
Show us where authorizations and documentation slip. In a 30-minute walkthrough, we will show how EnsureCare clears them before the claim goes out.