Eliminate revenue leakage from Emergency Department (ED) downgrades and start receiving full and rightful reimbursement.
Finding and correcting downgrade errors requires clinical insight, payer intelligence, and data-driven precision. EnableComp takes a rigorous approach to resolving ED downgrades as we:
EnableComp’s ED Downgrades solution, part of our Complex Denials Suite, delivers measurable impact on its own and results amplify when connected to the full suite.
Most ED downgrade review processes stop at surface-level checks. EnableComp goes deeper, combining clinical expertise with intelligent automation to correct inaccurate downgrades.
Our team reviews each claim with a thoughtful, methodical approach, using clinical indicators, documentation, and the broader clinical picture to give your organization a clear and reliable foundation for reimbursement.
EnableComp's adaptive e360 RCM platform helps detect downgrade trends by payer, diagnosis, and facility to reveal root causes and financial exposure across your Emergency Department.
Findings from each review feed directly into documentation improvement initiatives, reducing future downgrades and strengthening overall documentation quality and consistency.
Every recovered claim is validated against payer criteria, coding guidelines, and contract terms, ensuring accuracy, defensibility, and measurable financial impact.
Beyond immediate recovery, EnableComp equips hospital teams with actionable intelligence that informs training, supports payer negotiations, and sustains long-term revenue integrity.
We identify downgrade triggers, reimbursement thresholds, and level-of-care criteria across payers.
We pinpoint documentation gaps, coding inconsistencies, and patterns behind downgrades.
We deliver targeted insights to improve first-pass yield and strengthen appeal defensibility.
We support retrospective reviews, appeal workflows, and education loops for coding teams.
EnableComp applies Complex Revenue Intelligence™ (CRI) to every ED downgrade review, combining advanced analytics, payer intelligence, and clinical expertise to identify discrepancies between documented care and payer reimbursement.
One key to CRI is our proprietary AI-enhanced e360 RCM® platform, which continuously learns from the millions of claims it processes. This intelligence enables hospitals to recover lost revenue, prevent future downgrades, and ensure every claim accurately reflects the level of care provided.
Built for foresight, CRI transforms complexity into sustainable financial performance.
Each solution in our Complex Denials Suite delivers results on its own, but when hospitals partner with EnableComp for all four – ED Downgrades, DRG Downgrades, Medical Necessity Denials, and Coordination of Benefits (COB) Denials – the impact multiplies.
We offer denial solutions for every type of commercial and complex denial; if you’re struggling with denials, we can help.
Our integrated expertise and proprietary technology align every aspect of denials management and prevention, unlocking financial outcomes once considered out of reach.
