U.S. hospitals lose $262B to denials every year
Recover the revenue your team is leaving behind.
AI agents + human expertise in one platform.
Orbion unifies every step of the denial lifecycle - from prevention to appeal - in a single platform. No more spreadsheets, no more portal-hopping, no more revenue left on the table.
Denied annually across U.S. hospitals
Of denied claims never resubmitted
Average cost to rework a single denial
Of denials are preventable
Sources: MGMA, HFMA, Change Healthcare
Today’s tools weren’t built for this volume
The result: lost revenue, burned-out staff, and zero visibility.
Denials are rising but root causes are unclear
Without centralized data, your team patches individual denials instead of preventing them at the source.
Felt most by: CFO / VP Revenue Cycle
AR over 60–90 days is choking cash flow
Claims past 60 days are 2–3x less likely to recover. Working capital dries up while finance scrambles for answers.
Felt most by: Controller / Finance Director
Teams are understaffed and buried in rework
Experienced specialists spend their day on copy-paste work between EHR, payer portals, and shared drives.
Felt most by: Billing Manager / AR Lead
No real-time insight into payer behavior
By the time you notice a payer changed adjudication patterns, hundreds of claims have already been denied the same way.
Felt most by: Revenue Integrity Director
Constant firefighting instead of strategy
Every week is triage. The strategic work that moves the needle - prevention, payer negotiations - never gets done.
Felt most by: VP Operations / RCM Director
How much are denials really costing you?
Adjust the sliders to match your organization. See the real revenue at risk - and what Orbion can recover.
Recoverable with Orbion (annually)
$1,170,000
Based on 65% recovery rate
Monthly denied claims
750
Annual revenue at risk
$1,800,000
Annual cost of manual rework
$1,062,000
Assumptions: 65% recovery rate based on industry benchmarks, $118 average rework cost per denial (MGMA), 12-month projection. Actual results vary by specialty, payer mix, and denial complexity.
Works with
and moreOrbion
Unified Agentic Denial Management
Connects to
and moreConnects to the systems you already use
Orbion sits at the center of your revenue cycle, pulling denial data from every source and pushing resolutions back - without replacing a single tool in your stack.
- Bi-directional sync - read claims data from your EMR, write back appeal outcomes and status updates automatically
- Automated denial data ingestion - 835s, ERA files, and portal scrapes from every payer, normalized in minutes
- Real-time claim status updates pushed to your team - no portal-hopping, no manual checks
- Zero disruption - overlay architecture sits alongside your current stack, no EHR migration required
Ready to stop the revenue bleed?
Live in weeks, not months. No EHR migration required.
Twelve steps.
One platform.
Nothing falls through.
From the moment a denial lands to the moment revenue is recovered, Orbion manages every step - so your team can focus on the work that matters.
Denial Receipt & Intake
Automated ingestion from all payer sources - 835s, ERA files, portal scrapes - normalized into a single queue within minutes.
Triage & Prioritization
Every denial is scored by dollar value, overturn probability, and deadline proximity. Your team works the list top-down - no guessing, no wasted effort.
Root Cause Classification
AI-assisted CARC/RARC mapping identifies why each denial happened - coding error, missing auth, timely filing - so you fix causes, not symptoms.
Gap Identification
Orbion flags missing documentation, authorization gaps, and information deficiencies before your team starts the appeal.
Evidence Assembly
Clinical notes, prior authorizations, medical records, and supporting documentation pulled together automatically from connected systems.
Appeal Preparation
Pre-built appeal letter templates populated with claim-specific data. One click generates a payer-compliant appeal package.
Submission & Tracking
Appeals submitted electronically where possible, with real-time status tracking and automated follow-up scheduling for every open case.
Payer Response Management
Responses ingested automatically, outcomes recorded, and next actions triggered - whether that's escalation, second-level appeal, or closure.
Escalation & Second-Level Appeals
Unresolved denials route automatically to senior staff or external review. Escalation criteria are configurable by payer, denial type, and dollar threshold.
Recovery & Payment Posting
Recovered revenue reconciled against original claims. Payment variances flagged and posted back to your billing system automatically.
Prevention & Feedback Loop
Denial patterns analyzed across payers, departments, and providers. Root cause insights pushed upstream to prevent future denials before they happen.
Reporting & Compliance
Executive dashboards, payer scorecards, and audit-ready reports. Every action logged, every deadline tracked, every dollar accounted for.
Every step logged. Every action auditable. Every deadline tracked.
Built for the way denial teams actually work
Four pillars that transform denial management from reactive firefighting into a structured, measurable operation.
Integration
Universal Payer Connectivity
Connect to every payer portal, clearinghouse, and remittance source through a single integration layer. No more manual downloads, no more missed ERAs.
Without Orbion: Manual ERA downloads from 12+ portals every day
With Orbion: ERA processing in minutes, not hours
Intelligence
Orbion Score
Every denial gets a score from 1 to 100 - weighted by dollar value, overturn probability, and deadline proximity. Your team works the list top-down. No guessing. No wasted effort.
Without Orbion: Gut-feel prioritization and stale spreadsheets
With Orbion: Focus effort where it recovers the most revenue
Automation
Agentic Workflow Engine
Rules-based routing, automated task assignment, deadline tracking, and escalation paths. Configure once, then let the system enforce consistency across every denial.
Without Orbion: Manual routing, missed deadlines, inconsistent follow-up
With Orbion: Eliminate 80% of manual routing and follow-up tasks
Recovery
Appeal Command Center
Pre-built letter templates, evidence assembly, electronic submission, and real-time tracking. Everything your team needs to prepare, submit, and follow up on appeals - in one place.
Without Orbion: Copy-paste appeals assembled across 4 systems
With Orbion: Appeal preparation in hours, not days
And that’s just the beginning.
Every module is built to work together - giving your team a unified workspace for the entire denial lifecycle.
Denial Dashboard
Real-time view of open denials, recovery pipeline, and team performance
Letter Generator
Auto-populated, payer-compliant appeal letters from claim data
Trend Analytics
Denial patterns by payer, root cause, department, and provider
Team Workqueues
Prioritized task lists assigned by role, payer, and deadline
Deadline Tracker
Countdown timers for every filing window - nothing expires silently
Payer Scorecards
Overturn rates, response times, and denial patterns by payer and plan
Audit Trail
Timestamped log of every action, decision, and status change
Bulk Export
One-click export of reports, claim data, and compliance packages
Every quarter you wait, the gap widens
Denial volumes are rising, teams aren’t growing, and payers are learning that your claims are easy to deny. The write-offs compound.
Denial rates are up 20% year-over-year since 2021 - and payers are now deploying AI to auto-deny claims at scale
The average hospital writes off $4.9M in recoverable revenue annually because teams can’t work the queue fast enough
CMS expanded prior auth requirements again in 2025 - each rule change triggers a new wave of preventable denials
Every unworked denial trains payers that denying your claims has zero consequences. The longer you wait, the more they deny
Built by the people who lived this problem
Orbion was founded by revenue cycle operators, software engineers and architects, and security experts who spent years fighting denials with the wrong tools.
Enterprise Engineering
Scalable architecture for health system volume
Healthcare Security
HIPAA-compliant infrastructure built from day one
Health System Finance
Deep understanding of revenue cycle economics
Revenue Cycle Operations
Built by people who lived the denial problem
Built for Every Tier of Care
Hospitals
Multi-facility denial intelligence across complex payer contracts, prior auth requirements, and high-volume claim flows.
Specialty & Surgical Groups
Denial logic tuned for high-complexity specialties - Cardiology, Oncology, Orthopedics - where medical necessity denials hit hardest.
Labs & Diagnostics
Purpose-built workflows for reference labs, pathology, and molecular diagnostics - where prior auth and coverage denials dominate.
See how much revenue you’re leaving on the table
Get a personalized revenue impact analysis in a 30-minute walkthrough. Your data, your payer mix, your recovery potential. No slides.
Free for qualified health systems. Live in weeks, not months.