What would it take to stop solving the same denial twice?
For revenue cycle leaders, recovering unpaid claims is only part of the equation. The greater opportunity lies in understanding why those claims were denied and using that intelligence to prevent the same issues from recurring.
That was the focus of Joyful Health's workshop, Prevention Is the Best Medicine for Improved Financial Outcomes, featuring Becky Carlson, Head of Revenue Cycle Management at Joyful Health, and Eric Worthan, CEO of Ally Psychiatry.
With 71 locations across seven states, Ally Psychiatry understands the complexity of managing revenue cycle operations at scale. Worthan joined Carlson to share how Ally is strengthening its revenue cycle infrastructure and what healthcare organizations can learn from a more proactive approach to denials.
Here are five takeaways from the conversation:
1. Visibility is only valuable when it leads to action
Healthcare organizations have no shortage of revenue cycle data. EHRs, clearinghouses, payer portals, and financial reporting tools all capture pieces of the payment journey.
The challenge is connecting those pieces into something actionable.
Worthan described Ally's journey toward better visibility as moving from pitch black, through opaque, toward transparency. The information was there, but turning it into meaningful intelligence required a different approach.
A report showing 500 denials under one code might highlight a problem. Understanding what's driving those denials, how much revenue is at risk, and who can address the underlying issue is what makes the information useful.
The takeaway: Better reporting starts with better questions. Revenue cycle leaders need to know what happened, why it happened, and what should happen next.
2. Prevention starts with getting the fundamentals right
As Ally expanded across states and care settings, maintaining consistency across credentialing, payer contracts, and charge capture became increasingly important.
When Worthan joined in 2024, his first priority was strengthening those operational foundations.
Only then could the organization begin addressing denial patterns more systematically.
Carlson reinforced the importance of sequencing, particularly as organizations introduce AI into revenue cycle workflows. Technology can accelerate investigation and execution, but reliable processes are essential to producing reliable results.
For Ally, the next step was finding a partner with the specialized expertise to turn claim-level information into actionable intelligence without diverting internal resources from patient care.
The takeaway: A prevention-focused revenue cycle needs both strong upstream processes and the ability to identify where those processes need improvement.
3. One denial code can tell several different stories
During the workshop, Carlson demonstrated how claims carrying the same denial code can originate from entirely different operational issues.
Take CO-16, commonly associated with missing or incomplete information.
Behind that single code might be a missing modifier, an incorrect provider taxonomy, or a claim assembly issue. Each requires a different corrective action.
Joyful Health combines AI-supported claim investigation with experienced RCM specialists to uncover those differences, determine the appropriate next steps, and identify patterns across claims.
Worthan highlighted why that broader perspective matters. Resolving one claim is valuable. Recognizing that the same issue has affected 15 other claims creates an opportunity to address the underlying cause.
The takeaway: Denial codes tell you where to start looking. Claim-level investigation reveals what needs to change.
4. Recovery work can reveal opportunities for prevention
What happens to the information uncovered during denial recovery?
Carlson shared an example involving durable medical equipment claims repeatedly denied because of how service units were submitted. Investigating the pattern revealed a specific adjustment that could reduce future denials while preserving expected reimbursement.
Ally encountered a similar challenge when Alabama Medicaid changed its claim assembly requirements. Managed Medicaid plans adopted those changes inconsistently, making the emerging pattern difficult to identify through routine claim review.
Joyful's investigation surfaced the issue within the first weeks of the engagement with Ally, creating an opportunity to incorporate the findings into future workflows.
“[Joyful's] data and software pulled it together in a way that let us go fix it,” Worthan said of the Alabama Medicaid change. “We then built it into the knowledge engine, so we won’t make that mistake again going forward.”
The takeaway: Every recovered claim can provide intelligence that helps prevent the next denial, provided those findings reach the teams responsible for making changes.
5. Prevention requires an ongoing feedback loop
Payer requirements will continue to change. New locations, service lines, and contracts will introduce additional complexity.
The goal is to build a revenue cycle that can recognize and respond to those changes consistently.
For Ally, that means establishing regular conversations around what denial investigations are revealing and what needs to change upstream.
"It's not just about how many claims we worked but what we learned," Worthan said. "This helps us understand what we need to fix on the front-end."
Rather than focusing exclusively on claims worked or dollars recovered, these discussions connect recurring patterns to operational decisions.
It's a shift from measuring recovery activity to understanding how recovery intelligence can improve future performance.
The takeaway: Sustainable denial prevention requires a repeatable process for investigating claims, identifying patterns, implementing changes, and monitoring results.
See prevention in action
Recovering revenue, identifying root causes, and preventing denials are connected parts of a stronger revenue cycle.
When claim-level investigation informs operational decisions, healthcare organizations can reduce repeat work, improve financial visibility, and create more predictable collections.
In the full conversation, Carlson and Worthan go deeper into Ally's experience, demonstrate how Joyful Health investigates and resolves complex denials, and share real examples of turning recovery insights into prevention strategies.
