Changelog
Follow up on the latest improvements and updates.
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We're serious about making denials an obsolete concept.
How often do insurers/payers deny patient care?
And that's an unfortunate reality.
Therefore, denyify is crowdsourcing payer denials reporting, aiming to bring transparency to healthcare. If you are a provider that has historical claims denials you'd like to report on, we welcome your partnership in sourcing denials data.
Provider-originated payer denials data
We're empowering providers, researchers, and even other health tech organizations with access to this data, because we believe that transparency in healthcare is vital to solving its most challenging and complex problems.
Navigate to denyify's Report Denials page and complete the form. Each submission is limited to a single payer but may include multiple reason codes, CPT codes, and remarks.
We collect data, you get access.
To protect this data from spam, bot crawls, or any other public risks, we are requiring a free denyify account to access the entire database. Once you're inside, you're free to download and use for your own research.
We'll only contact you to validate your submission(s) and understand how you are currently handling denials in your organization.
For disclosure purposes, we are using this public dataset in addition to our private data to fine-tune our own software offerings and build an irrefutable system to create undeniable care. We encourage you to do the same, as this is a give-and-get model, and we're happy to host/lead it.
Thank you all for your tremendous support.
My Appeal Style unlocks personalized appeals
Are you a fierce advocate for your patient? Do you believe in the power of personalized care and tailored treatment plans? If so, then
My Appeal Style
is here to complement your advocacy and revolutionize the way you approach patient appeals.denyify understands that every patient is unique, and their healthcare journey should reflect that. That's why we've created
My Appeal Style
-- a new feature on our AI appeals platform empowering you to create personalized appeals which ensure your unique voice is heard.Gone are the days of generic appeal templates and one-size-fits-all strategies.
For current users, navigate to your Account Settings and click into your Profile. At the bottom you will see text saying "Change my appeal style" - click this and the following window will open.
We recommend that you write in first-person and focus on "I" statements.
With
My Appeal Style
, in just a few clicks, you can generate persuasive appeal letters in your voice, style, and tone.Discover your appeal style today and deliver your impact at scale.
We're kicking off June in a fantastic way - with a complete, post-MVP replatforming of denyify.
Due to needs around performance, reliability, and enterprise-readiness, we needed to split the website and app platform across multiple resources (versus only 1 in the MVP).
Website Redesign
The new site redesign features a seamless user journey - from a powerful hero CTA, to a journey of curiosity, ultimately leading prospective users down the funnel to our new 60-day free trial (no credit card required).
Why did we make this decision to offer a trial, and specifically one that lasts for 60 days?
Since emerging from stealth in March, the hundreds of conversations we've had with peers in industry, actual pained users (physicians, advocates, billers), as well as partners & potential partners, one thing became clear:
payer reimbursement terms are a burden on all providers.
And these terms can be an upwards of 60 days. AR? More like
AR
gh!denyify levels the playing field to give providers a fighting chance against payer automation & AI -- so we're extending and recommending 60-day trials for all new users as we join you in this fight.
App Redesign
We've also redesigned denyify's UI with
scaling
and enterprise-readiness
in mind. Now you can easily:- Review your appeals history
- Monitor your account security
- Modify your account/profile settings
- Search our knowledge base
- Open, copy, and export historical appeals
- Access live chat wherever in the app
- Create an appeal in a focused view
And as we officially release our upcoming features. you will see them populated on the left sidebar.
Added Speech Pathology specialty
And as a final sendoff in this first full week of June, we're excited to release a new specialty as part of our Specialty Workflows feature. For speech pathologists who are subscribed to
Essentials
or higher, you will now have the contextual nuance of your specialty crafted into each appeal.
Accurate, non-hallucinating medical references with AI?
🥁 drum roll please...
In early April, we began discovering and experimenting with the idea of references and citations based upon appeal context.
Early on in denyify's development, we prompted for direct references but the AI hallucinations were too severe that there was no good production use case... until now!
Clinical Citations (a beta program)
Featuring the cutting-edge of applied AI, Clinical Citations uses contextual claims data to search and return evidence-based reasoning with appropriate and relevant references.
For example, take a patient who has been suffering with vascular dementia and as a result has been experiencing behavioral disturbances (such as falls). The prescription of a durable mobility aid (such as a walker or cane) would appear reasonable, appropriate, cost effective, and medically necessary.
Let's take those treatment/condition inputs and see what our clinical citation AI can find.
Treatment: walker or cane as a mobility aid
Condition: vascular dementia with behavioral disturbance
Clinical Citation Output: The recommended treatment for mobility assistance is to use either a walker or a cane.The individual has vascular dementia, which is a type of dementia caused by reduced blood flow to the brain. They also exhibit behavioral disturbances.The article "Walking and Dementia in Physically Capable Elderly Men" published in JAMA suggests that physical activity, such as walking, may reduce the risk of developing dementia in elderly men who are physically capable [1]. The study found that men who walked less than a quarter mile per day had a higher risk of developing dementia compared to those who walked more than two miles per day [1]. Therefore, prescribing regular walking as a form of physical activity may be medically necessary for physically capable elderly men to reduce their risk of developing dementia. [1] (https://jamanetwork.com/journals/jama/fullarticle/199484)
As you can see, we're
almost
there. The treatment/condition were found paired in research found in a JAMA journal, however the nuance of "fall risk" or otherwise was excluded and the use case was positioned as benefit to the patient (e.g. how walking can help with their condition).Let's try it again, this time with a specific ICD10: Z91. 81 (History of falling).
Treatment: walker or cane as a mobility aid
Condition: vascular dementia with behavioral disturbance and a history of falling (Z91.81)
Clinical Citation Output: The treatment involves the use of a walker, which is a mobility aid.The person has dementia and a history of falls.Regular exercise has been shown to reduce the likelihood of falling in older adults, even if the exercise was performed a quarter of a century earlier [1]. Additionally, gait speed has been identified as a predictor of survival in older adults, with slower gait speeds being associated with increased mortality rates [2]. These findings suggest that exercise interventions aimed at improving gait speed and balance may be medically necessary for older adults to reduce the risk of falls and improve overall survival. [1] (https://pubmed.ncbi.nlm.nih.gov/28369185/), [2] (https://jamanetwork.com/journals/jama/fullarticle/644554)
While the argument being made makes sense, we are still left with whether or not the patient history supports this reasoning, whether the appeal itself would benefit from these citations, and overall if a medical director would feel sufficiently persuaded.
Source [1]
Source [2]
Now, all hope is not lost, as we have covered an enormous ground in being able to take patient treatment/conditions data, generate an appeal, and then use that same data to generate citations which support the argument in-appeal.
It's
absolutely
not perfect, and sharing this is no intention of marketing as it will not be ready for some time. The goal of this update is to share with our community of current users, prospective users, partners, and potential partners, the power of denyify and what we're building here.We're currently green-lighting this for access to Beyond plan users exclusively, and look forward to rolling this out sometime in late july or early August 2023.
New kid on the block
We're rebranding Practice Specialty Profiles to
Specialty Workflows
.With Specialty Workflows, we deploy contextually-relevant workflows which drive greater clinical accuracy. For example, a cardiologist would argue & present information differently compared to a primary.
As of this post, denyify currently supports the following specialties:
- Plastic surgery
- Rheumatology
- Emergency medicine
- Radiology
- Critical care
- General surgery
- Physical medicine and rehabilitation
- Anesthesiology
- Orthopedics
- Pulmonary medicine
- Neurology
- Infectious diseases
- Urology
- OB-GYN
- Allergy and immunology
- Oncology
- Psychiatry
- Gastroenterology
- Dermatology
- Internal medicine
- Cardiology
- Nephrology
- Family medicine
- Dentistry
- Otolaryngology
- Pediatrics
- Diabetes and endocrinology
- Gerontology
- Ophthalmology
new
improved
New Efficiencies for PSP
Incredible improvements delivered with practice profiles
We are excited to share results from our initial PSP (Practice Specialty Profiles) trials, where we have observed significant improvements in our ability to generate highly performant medical necessity appeals.
What are Practice Specialty Profiles or PSPs?
Practice Specialty Profiles
are a way we have fine-tuned provider nuance into our appeals generation process.For example, consider a general patient advocate and a specialty provider.
General Patient Advocate
- May have limited knowledge of the medical condition or procedure, leading to less clarity of purpose and description of the patient's medical condition
- May not be able to provide a detailed explanation of the benefits of the treatment, as they may not have specific knowledge of the patient's case
- May rely on patient-reported information, which may not be as credible as other forms of evidence
- May not have access to the same level of specialized evidence to support the appeal, potentially affecting the persuasiveness of the appeal
- May not be as familiar with the cost-effectiveness of the treatment for the specific condition or procedure, which could impact the strength of the appeal
Specialty Provider
- Has specific knowledge of the medical condition or procedure, which can lead to greater clarity of purpose and a more detailed description of the patient's medical condition
- Can provide a more thorough and detailed explanation of the benefits of the treatment based on their specialty knowledge and experience
- Has access to specialized evidence to support the appeal, which can increase the persuasiveness of the appeal
- Can use credible evidence to support the treatment based on their specialized knowledge and experience
- Has a better understanding of the cost-effectiveness of the treatment for the specific condition or procedure, which can make the appeal more compelling and persuasive.
While these two profiles may seem diametrically opposed, truthfully they are. Over time, general advocacy (while sufficient) will be unable to stand up to the context and nuance originating from a specialty provider. Considering attributes such as tone, clarity, persuasiveness, specificity, confidence, and specialty point of view, the specialty provider offers a stronger insight into the
why
behind a patient's treatment.Implementing specialty workflows is only an extra step..
PSP vs. No PSP
We analyzed the language differences between appeals with and without PSP training, and identified four attributes -
clarity
, persuasiveness
, specificity
, and confidence
. Using on these attributes, we assigned percentages based on RLHF to indicate how well each output performed on each attribute. We observed that the appeal with PSP training performed better overall, as it scored ~50% higher on all attributes compared to appeals without.We repeated the analysis with the same four attributes. We found that appeals with PSP training performed 56% better based on RLHF averages compared to appeals without.
Average +56% appeal language improvement with PSP
Practice Specialty Profiles (PSP) have shown incredible promise in the early release to
Beyond
plan users.
In reviewing the materials contents and consulting our
AutoGPT
for secondary insight, we identified five attributes that were different between the two outputs - clarity of purpose
, description of the patient's medical condition
, explanation of the benefits of the treatment
, use of credible evidence to support the treatment
, and emphasis on the cost-effectiveness of the treatment
. Through an additional round of RLHF, we observed that the appeal version with PSP performed better on these additional attributes.We have observed consistent and significant improvements with the implementation of PSP. We have seen improvements in clarity, persuasiveness, specificity, and confidence, and will continue to monitor and make further improvements as necessary.
v1.5.6-U (GPT-4 Upgrade)
We've upgraded prompt model v1.5.6 to use GPT-4 and have applied this functionality to
ALL
plans. Therefore at this time, ALL
denyify users are receiving an elevated
, unparalleled
, and premium
experience when it comes to cutting-edge, applied AI (there's a surgeon joke in there).Interestingly enough, as shown in GPT-4 vs. GPT-3.5 public results, we have seen an equal ~20% improvement across all appeal generations by specialty. Some specialties have shown significantly more improvements than others, however all meet or exceed this ~20% benchmark improvement.
Practice Specialty Profiles
We are thrilled to introduce our new, innovative feature:
Practice Specialty Profiles
. Designed to elevate the appeal generation experience, this feature brings a new level of precision and expertise to your account.Upon creating your account, Practice Specialty Profiles are preset to guide our advanced GPT-4 model along a distinct path for each appeal generation.
The result? Appeals which are crafted with real-time, specialty-specific context, reflecting the insights and expertise of a specialist in the field.
This feature goes beyond the knowledge of a general medical professional, delivering appeals that speak with the authority and understanding of a true expert in the specialty.
The Practice Specialty Profiles feature is currently available exclusively for our
Beyond
plan users. As a Beyond
plan user, you can enjoy seamless access to this feature, as it will be automatically enabled by default—no additional action required.Experience the power of specialty expertise with
Practice Specialty Profiles
.User Appeal History
We're excited to announce the rollout of a new beta feature designed to enhance your experience with appeal generation.
We understand that it can be frustrating to generate an appeal, only to forget to copy or save it before moving on to another task or exiting the session. To address this challenge, we've introduced a convenient way to access and manage your appeal history—all within the main app page.
To access this feature, simply scroll to the bottom of your screen, and you'll find the following key functionalities.
- Comprehensive Appeal History:View a detailed history of Conditions, Treatments, and Appeals you've generated in the past.
- Easy Export and Save:Effortlessly export and save each historical appeal as a PDF, ensuring your appeal documents are always accessible.
- Seamless Navigation:Use the Previous and Next buttons to easily navigate through your appeals, one at a time, for a smooth and efficient review process.
We're also exploring additional enhancements to improve your experience, including:
- Historical Appeals Search:Quickly find and access specific appeals using our search functionality.
- Improved UI/UX:Enjoy a more intuitive and user-friendly interface for seamless appeal management.
- One-Click EHR/EMR/Billing Export:Integrate your appeals directly into your EHR, EMR, or billing software with a simple one-click export.
We're committed to providing you with tools that make your appeal generation process as streamlined and efficient as possible. Thank you for choosing denyify, and we look forward to your valuable feedback on this new feature.
new
improved
Release: Prompt Model v1.5.6
v1.5.6
Our latest prompt model, v1.5.6, focuses on evolutionary improvements for enhanced clinical writing and medical appropriateness of care determination. We want to assure you that while versions v1.5 through v1.5.5 were iterative, v1.5.6 offers significant advancements in the safety & training language.
Here are some of the improvements you can expect:
- Enhanced Clinical Writing Training:Our latest version features improved training for clinical writing to ensure that the language used in prompts is accurate and clear, easily conveying necessary information.
- Improved Determination of Medical Appropriateness of Care:The new release offers better determination of medical appropriateness of care, which helps to reduce the risk of misrepresenting incorrect treatment plans and denials (based upon medically acceptable treatment).
- For instance, if you provide an incorrecttreatment for anincorrectcondition, the result will still beincorrect, however the determinant logic will be improved (e.g. aknee sprainrequiringamputationwill be evaluated in the most logically determinant way).
"...Amputation can alleviate pain, reduce swelling, and improve mobility, allowing patients to resume their daily activities and improve their overall quality of life.
I understand that amputation may seem like an unconventional treatment..."
- Better Step-Logic for Specific Requirements Pertaining to Medical Necessity:With our enhanced step-logic, our prompt model can accurately assess the specific requirements for medical necessity on a condition/treatment basis. Currently, only 1:1 pairs have been thoroughly tested, however the step-logic will recursively assess each condition/treatment pairing without limit.
- Redesigned Conversational Elements to Optimize for Specialty Outcomes:We have optimized our conversational elements for specialty outcomes to ensure that a plastic surgery appeal is correctly nuanced for conditions and treatments which relate to plastic surgery, and that there is not a misrepresentation of another specialty area (e.g. podiatry).
We are committed to delivering the best possible experience to our users and believe that this latest version of our prompt model takes us one step closer to achieving that goal. Thank you for choosing denyify.
new
improved
Live on GPT-3.5 Turbo 🏎️
We're fully integrated and live on GPT 3.5 Turbo!
With this new integration, our users can now access even more advanced language processing capabilities to take appeal generation to the next level.
Here's what's new in this update:
- GPT-3.5 Turbo integration:Our integration with GPT-3.5 Turbo brings advanced language processing capabilities to our platform. With GPT-3.5 Turbo, our users can now generate even more accurate and natural language responses to claim denials.
- Improved appeal generation:The denyify platform now generates higher-quality appeals.Beyondplan subscribers who have chosen theirpractice specialty profilewill now have enhanced appeals automatically included in each generation -- this means that each letter will be written by an AI that is trained to think like a practitioner for a given specialty.
- Faster performance:We've made significant improvements to our platform's performance, enabling users to generate appeals faster and more efficiently than ever before. GPT-3.5 Turbo processes information at lightning-fast speeds, making it easier than even our advertised "in 30 seconds" promise.
- Enhanced accuracy:GPT-3.5 Turbo's enhanced accuracy ensures that our platform generates more accurate and relevant content. Our users can be confident that the appeals they generate are well-written and targeted to the medically relevant needs for their patients.
We are thrilled to bring GPT-3.5 Turbo to our users and believe this update will help take appeals automation efforts to the next level. As always, we welcome feedback from our users and will continue to iterate and improve our platform to meet their needs.
We're excited to share long awaited updates to the
denyify
experience.Authentication
Denyify is now equipped with authentication, tracking, and logging using Outseta (referral link). It's pretty amazing what Outseta can do for the price point they offer.
Export
Users are now able to directly edit their generated appeal and export to PDF. The export includes a dated, formatted letterhead with a user's organization details, for example:
MM/DD/YYYY
XYZ Clinic
123 Main Street
Cityplace, ST 10101
XXX-XXX-XXXX
YYY-YYY-YYYY
We're continuing to explore additional format opportunities for export. Understandably most practices have a templated letterhead that makes it easy to quickly fax/email with appropriate endorsements.
Ideally, in a future state release, denyify will allow you to setup & store your practice's templated letterhead in a PDF-friendly format. That way, you are guaranteed a familiar experience when generating each appeal.