AI Denial ManagementSoftware, Native toSalesforce
Predict denials before claims leave your office, see the root cause of every denial, and work appeals from one queue connected to your clearinghouse. Built for US clinics and providers.
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The Challenge
Claim denials are quietly draining US practice revenue
Most denials start with small, preventable errors: an invalid NPI, a taxonomy code in the wrong format, missing credentials, eligibility that was never re-verified, or a duplicate submission. Billing teams find out weeks later, then piece the story together across the EHR, the clearinghouse portal and a spreadsheet.
Learn MoreElixir brings that work into one place. Because it runs natively on Salesforce and connects directly to your clearinghouse, it checks every claim before submission and explains every denial the moment the remittance arrives.
Unrecovered loss
65%
of denied claims are never resubmitted by providers.¹
Front-end opportunity
90%
of denials are considered preventable with the right front-end checks.¹
Rework Cost per Occurrence
$25–$118
is the average cost to rework a single denied claim.¹
¹ Industry estimates. Replace with your preferred cited sources before publishing.
Unified Lifecycle
End-to-End Denial Management Workflow on Salesforce
Elixir covers the full claim denial lifecycle, from the first scrub to the final payment.
- 1
Predict
Every claim is scored for denial risk before it goes to the clearinghouse, with the reasons behind the score.
- 2
Prevent
AI claim scrubbing flags NPI, taxonomy, credential, coding and payer-rule issues and tells staff exactly how to fix them.
- 3
Resolve
When a denial arrives on the 835, Elixir classifies the root cause from CARC and RARC codes and recommends next steps.
- 4
Recover
Prioritized work queues, auto-generated appeal letters and timely-filing alerts move money back into your account.
Features
AI Claim Denial Prevention and Recovery Features
Purpose-built for billing teams at US clinics, physician groups and specialty practices.
Claim denial prediction before submission
See which claims are likely to be denied while there is still time to fix them. Elixir gives each claim a High, Medium or Low denial risk score right in your Salesforce list view, so your team works the riskiest claims first.
Risk scores based on payer history, coding and claim data- Color-coded claim lists and filters by risk band
- Hold high-risk claims automatically before submission
AI claim scrubbing with rejection probability
Elixir reviews the full claim and every line item, then shows the rejection probability, the specific issues it found and how to fix each one. Staff see a clear list of corrections instead of a cryptic clearinghouse rejection.
- Validates NPI, NUCC taxonomy, credentials and diagnosis pointers
- Checks modifiers, thresholds and payer billing rules by CPT
- Line-item rejection reasons with step-by-step fixes
CARC and RARC root cause analysis
Stop guessing why a claim was denied. Elixir reads the CARC and RARC codes on each remittance, classifies the root cause, such as coding error, eligibility, authorization or duplicate, and gives a confidence score with prioritized next steps.
- Root cause categories your team and leadership can report on
- Next steps ranked as urgent, important or informational
- Each step explains why, what to do and the expected outcome
Patient-level insights and next best actions
Denials rarely happen one at a time. Elixir looks across a patient's entire account to spot payer-level patterns, aging balances and eligibility gaps, then recommends the next best actions with the expected dollar outcome of each.
Integration
Denial Management Integrated With Your Clearinghouse
Elixir connects to your clearinghouse through standard X12 EDI transactions. Claims go out from Salesforce, and acknowledgments, rejections and remittances come straight back in. Denials land in the right work queue within minutes, already classified and ready to work, so your
team never logs in to a separate portal.
837
Claim submission
Professional and institutional claims sent from Salesforce.
Outbound X12999
Acknowledgment
Front-end rejections surfaced instantly with fix guidance.
Instant Telemetry277CA
Claim status
Payer acceptance and rejection tracked on every claim.
Real-Time Tracking835
ERA remittance
Auto-posting, CARC and RARC capture, and denial routing.
Auto-Posting270/271
Eligibility
Real-time eligibility and COB checks before the visit.
Verification
Why a Salesforce Native Denial Management Solution
Your denials, patients, payers and providers share one data model, so nothing gets lost between systems.
One source of truth
Clinical notes, charges, claims and denials live in the same Salesforce org as your EHR, patient portal and contact center.
Dashboards you already know
Track denial rate, first-pass yield, days in AR and appeal success with standard Salesforce reports and dashboards.
Work queues and automation
Route denials by payer, root cause, dollar value or specialist using Salesforce flows, assignment rules and SLAs.
Automated appeals
Generate payer-ready appeal letters with the right documentation attached, and track every appeal to resolution.
Enterprise-grade security
HIPAA compliant, with role-based access, field-level security, encryption and full audit history.
Scales with your practice
Start with one clinic and grow to multi-location groups without adding another billing system.
Denial Management Software for US Clinics and Providers
Elixir supports the payer mix, specialties and workflows of healthcare organizations across the United States, including Medicare, Medicaid and commercial payers.
Independent medical practices
Behavioral health & mental health practices
Multi-specialty physician groups
FQHCs & community health centers
Urgent care centers
Addiction recovery centers
Physical therapy clinics
In-house billing & RCM teams