Denied claims traced back to one unchecked date
A hospital revenue cycle team whose denials were driven by authorizations that had expired before the date of service.
The situation
A hospital revenue cycle team. Its denials were driven not by clinical disputes but by administrative ones, and the largest single cause was an authorization that had expired before the date of service.
Authorization validity was confirmed at scheduling and then never re-checked. A procedure that moved to a later date silently invalidated its authorization, and the denial was worked after the fact, one appeal at a time.
The rule Ceertia applies
The insurance authorization must be valid on the date of service, not on the date it was requested.
How it runs
The case arrives from whoever sends it, with the insurance authorization, service records, billing codes summary, referral letter, patient identity and payer policy rules. Anything missing is flagged on receipt.
Each rule returns a verdict with its evidence: what Ceertia saw, where, and why it concluded. Every verdict is stored with its rule version, source excerpt and timestamp. Use cases across the main service lines. Each reads the date of service from the record and checks the authorization against that date specifically, citing both the authorization and the service date it was compared to.
Your team keeps the decision, on sourced evidence, with a full audit log.
What changes in the work
- Authorization validity was confirmed at scheduling, then never re-checked.
- A procedure that moved to a later date silently invalidated its authorization.
- 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 authorization is flagged before the claim is submitted.
- Each verdict cites the authorization and the service date it was compared to.
Your team keeps the decision, on sourced evidence, with a full audit log.
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