Stop Revenue Leakage in
Your Infusion Revenue Cycle

In most mid-market infusion organizations, elevated denial rates trace back to a small number of root causes: prior authorization mismatches, drug-to-diagnosis inconsistencies, eligibility coverage lapses, and timely filing breakdowns on secondary claims. The key is that these root causes are not randomly distributed. They concentrate by payer, by therapy type, and often by site. Without a cross-site analytics view that surfaces patterns rather than individual claim errors, the root causes remain invisible while the denial rate climbs. A structured CARC code analysis is usually the fastest path to understanding where your specific organization is losing revenue.

Top-quartile infusion organizations maintain denial rates below 7 percent, days in AR under 30, and referral conversion above 60 percent. They achieve this not by hiring more billing staff but by having a consistent exception analytics process that surfaces at-risk claims before submission, tracks payer performance against contracted rates, and monitors AR aging by bucket in near-real-time. The infrastructure is what separates the top quartile from the mid-market average, not the size of the billing team.

The most direct method is CARC code concentration analysis: pulling all denied claims over a 12 to 24 month period, grouping them by claim adjustment reason code, and then cross-referencing those code clusters against payer, therapy type, site, and submission date. This analysis almost always reveals that a significant portion of denials, often 70 to 80 percent, cluster around three to five specific patterns. Each pattern has a specific upstream cause and a specific remediation path. The analysis can typically be completed in two to three weeks with the right data connections in place.

A billing company works the queue. They submit claims, follow up on denials, appeal when appropriate, and collect payment. SolisRx builds the analytics layer that sits upstream of the queue, identifying which claims are at risk before they’re submitted and why denial patterns are emerging. These two functions are complementary. Many SolisRx clients continue working with their existing billing vendors; the analytics layer reduces the billing company’s workload and improves their collection rates simultaneously.

Authorization expiration denials are one of the most preventable denial categories, and they’re largely a monitoring failure rather than a process failure. The fix is a standing report that surfaces all active authorizations with remaining visits and days until expiration, sorted by proximity to the expiration date and by dollar value at risk. With that visibility, your intake and clinical teams can proactively renew before expiration or reschedule encounters within the authorization window. SolisRx builds this as one of its standard RCM monitoring artifacts.