41% of providers now report denial rates above 10%, according to 2026 denial benchmarking data published by ExactRx. HFMA’s working benchmark range is 5% to 10%.
Exception management lets a system handle every case following a known rule, routing edge cases to human specialists. Intake, reason classification, evidence retrieval, routing, and first appeal draft run automatically; anything below the confidence threshold goes to a specialist.
Why did denial volume rise in 2026?
Payer-side review automated while provider-side review stayed manual. Prior authorization denials rose 31% year over year (Medical Billers and Coders 2026 analysis). In addition, CMS-0057-F requires payers to issue specific denial reasons with citations, and 2026 NCCI bundling edit updates altered code pairs.
Denial management workflow: traditional vs emerging
| Step in Denial | Traditional Workflow | Emerging Exception Workflow |
|---|---|---|
| Intake | Biller keys 835 into worklist | System ingests 835 on receipt |
| Classification | Categorized by memory/habit | Classified by payer citation & root cause |
| Evidence | Manual request to HIM | Pulled automatically against reason |
| Routing | Worked in queue order | Routed by overturn likelihood & $ value |
| Appeal Draft | Written from static template | First draft assembled from evidence |
| Specialist Time | Spread thin across queue | Concentrated on complex exceptions |
What TSI Measures (PULSE RCM)
TSI’s PULSE denials and appeals work carries three measured figures:
- 86% denial overturn rate
- +43% payment per appeal
- -50% reduction in time to appeal
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Note: Outcomes depend on portfolio, age, payer mix, and documentation quality.
Here’s how TSI Healthcare RCM handles this work for providers. To see which claim-value bands are worth working at your cost per denial, try the denial economics calculator.