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Denials are rising
Initial claim denial rates reached roughly 11.8% in 2024, up from about 10.2% — and kept climbing in 2025. An estimated 41% of providers are now denied on more than one in ten claims.
Prevent, Not Pursue.
A prevention-first, AI-driven revenue cycle engine — predicting denials before claims go out, protecting net revenue, and recovering the few that slip through.
Three forces compound at once: denials keep climbing, payer rules shift constantly, and price-transparency mandates have become a permanent obligation. Most organizations react. Paladyn is built to prevent.
Initial claim denial rates reached roughly 11.8% in 2024, up from about 10.2% — and kept climbing in 2025. An estimated 41% of providers are now denied on more than one in ten claims.
Every payer maintains its own fee schedules, medical policies, prior-auth rules, and edits — and they change continuously. No manual team can keep pace with all of it, all the time.
Cost to collect already runs 2–4% of net patient revenue, and CMS v3.0 plus the No Surprises Act add a recurring, data-intensive transparency burden that resets every cycle.
Prevent. Not Pursue.
The goal was never to win the appeal — it's to never need one. Every dollar recovered downstream is a dollar that should never have been at risk. Paladyn engineers the revenue cycle so denials are designed out at the source: clean eligibility, airtight documentation, payer-aware edits, and pre-bill prediction that flags a claim before a payer ever sees it. We still build the tools to pursue the few denials that escape — but pursuit is the exception, not the operating model.
Every tool we build and every engagement we run traces back to these.
Predict future outcomes before they become write-offs.
Stop avoidable loss at the source, not in collections.
Defend financial health across the full revenue cycle.
Transform raw 835/837 data into decisions that hold.
Build what comes next — the tools we always wished we had.
Each stage feeds the next — and every outcome makes the whole system smarter.
Eligibility checks, upfront medical-necessity review, and pre-bill denial prediction surface risk before a claim is ever submitted.
Documentation-compliance prompts, payer-aware custom edits, and clean-claim engineering remove the root causes of denials.
For the few that slip through: automated technical and clinical appeals, underpayment review, and a prioritized AR work queue recover the cash.
Every remittance and outcome flows back into the payer-intelligence and analytics layer, so prediction sharpens with each claim.
Every product runs standalone or together as the Paladyn Suite, all built on Aegis — one secure data and AI foundation. The more you deploy, the smarter they get.
A secure, normalized data warehouse that links your 837 claims, 835 remittances, 276/277 statuses, and payer rules into one model — the substrate every Paladyn engine and dashboard runs on.
AI keeps every payer and government rule current and on demand — manuals, contracts, fee schedules, and edits in one place. Your team stops hunting through portals and gets the right answer the moment a claim needs it.
Automated price-transparency files and patient estimates without the spreadsheet grind. Drop in your data and publish compliant machine-readable files online with a single click — refreshed on schedule so you never fall out of compliance.
Executive dashboards and financial reporting that map your entire revenue cycle in one view. Automated KPIs turn raw 835/837 data into board-ready insight — clean-claim rate, denial rate, days in AR, net collection rate — with no manual report-building.
AI reads every claim before it leaves the building, flags the ones likely to be denied, and fixes the root cause first. What still slips through is appealed automatically — and every outcome trains the next prediction.
The accounts-receivable command center. Argus keeps claim status current automatically, scores every account by phase and dollars, and drives focused work queues — so effort goes where it actually returns cash.
The payer-connectivity gateway. Hermes reaches every payer over the best available rail — direct payer APIs, clearinghouses, or Medicare's own gateways — and returns one normalized status the whole platform can act on.
Secure SFTP intake, X12 parsing and generation, and HL7 / FHIR integration with your EHR — built in from day one.
Paladyn operates as a HIPAA Business Associate and is engineered from the ground up toward HITRUST CSF, with SOC 2 on the path. Protected health information lives only inside a dedicated, encrypted AWS environment behind a secure SFTP gateway — never in collaboration tools, never resold, never used for marketing.
Paladyn Health pairs senior revenue cycle leadership with engineers who build the AI that does the work. We've sat in the central business office, run the appeals, read the payer manuals, and balanced the credit balances.
We got tired of watching recoverable revenue walk out the door — so we're building the tools we always wished we had: prevention-first, payer-aware, and relentless about clean cash.
Texas-based. Founder-led. A HIPAA Business Associate from day one. Predict. Prevent. Protect.
Estimate the revenue your denials put at risk each year — and how much prevention can protect. 30 seconds, no PHI.
Open the calculator →A monthly email of notable payer and CMS policy changes that affect your claims. Free, no PHI.
We're taking on a small number of design partners to build alongside. Early access, direct input, preferred terms.
Become a design partner →Start with a revenue cycle assessment that quantifies your recoverable dollars and prioritizes the prevention opportunities with the highest return — no obligation.
Prefer email? info@paladynhealth.com