WVU MEDICINE · CUSTOMER CASE STUDY
More appeals.
Stronger teams.
Greater impact.
How WVU Medicine increased clinical appeal capacity 5X and defended $16 million in revenue with AppealNavigator™.
THE FIRST SIX MONTHS
$16Min revenue defended
Clinical expertise, supported by AI.
A more scalable way to manage appeals.
Results reported by WVU Medicine within six months of using AppealNavigator™.
Overview
WVU Medicine is one of the nation's largest academic health systems, with more than 25 hospitals and numerous outpatient locations serving patients across West Virginia, Pennsylvania, Ohio, Maryland, and Virginia. Across this complex revenue cycle environment, even small improvements in denial management can have a significant financial impact.
Facing rising denial volumes and increasing payer scrutiny, WVU Medicine partnered with The Wellington Group, LLC to implement AppealNavigator™, an AI-enhanced clinical appeals solution. The goal was to help internal teams pursue more appeals, reduce reliance on outsourced clinical denial vendors, and improve outcomes.
01 / THE CHALLENGE
The Challenge: Fighting Denials at Scale
More denials, greater complexity
Increasing denial volumes and payer scrutiny placed growing pressure on clinical denial specialists to recover revenue owed for patient care. Leadership needed a way to expand the team's capacity while supporting consistent, well-documented appeals.
Hours of preparation for a single appeal
Specialists often spent more than four hours researching, gathering documentation, and drafting one appeal. This manual effort limited the number of cases the team could pursue and made it harder to bring more clinical denial work in-house.
“The volume and complexity of clinical denials continue to increase every year. We needed a way to help our team work smarter, not harder.”
— Shari Boyer, Enterprise Director, Denial Management
02 / THE SOLUTION
The Solution: AI That Supports Clinical Expertise
AppealNavigator™ supports the expertise of appeal writers and clinical specialists by organizing clinical documentation, researching payer criteria, and generating appeal drafts for staff to review and refine. This gives experienced professionals more time to focus on appeal strategy and clinical arguments while maintaining a consistent process across the organization.
Organize documentation
Bring clinical information together to help staff present a clearer clinical picture and develop stronger support for medical necessity.
Research payer criteria
Support appeal preparation with research into payer criteria, helping staff build clinically justified arguments and reduce administrative effort.
Draft, review, and refine
Generate consistently structured appeal drafts that clinical staff can review, edit, and strengthen with their own expertise before submission.
“What impressed us most was how quickly the solution fit into our workflow. AppealNavigator™ gives our team immediate access to the information they need to build stronger appeals while maintaining consistency across our organization.”
— Jane Kennedy, Enterprise Director, Utilization Review & Inpatient Appeals
03 / THE TRANSFORMATION
Less Time Preparing. More Capacity to Act.
BEFORE
4+ hoursOften spent researching, gathering documentation, and drafting one appeal.
- Time-intensive manual preparation
- Limited capacity to pursue cases
- Dependence on outsourced clinical denial vendors
WITH APPEALNAVIGATOR™
Under 1 hourAverage appeal preparation time, with staff reviewing and refining AI-assisted drafts.
- 5X clinical appeal capacity
- 10,000 AI-assisted appeal letters in six months
- 72% reported appeal success rate
AI supports documentation, research, and drafting. Clinical professionals bring the judgment and expertise.
04 / THE PEOPLE
Stronger Appeals Across the Entire Team
The impact extended beyond productivity. AI-enhanced workflows helped WVU Medicine manage larger caseloads while improving appeal quality and consistency through clearer documentation, stronger medical necessity support, and consistently structured letters.
By standardizing best practices across junior and senior appeal writers, AppealNavigator™ helped strengthen the team's understanding of clinical validation, medical necessity, payer criteria, and denial refutation. These improvements contributed to higher overturn rates and more revenue defended.
“Utilizing AppealNavigator™ has allowed all appeal clinical staff to increase their knowledge, consistency, and effectiveness in writing outstanding appeal letters. In prior years, the strongest results were primarily produced by senior appeal writers; however, the use of AppealNavigator™ has expanded this capability across the entire team.”
— Lisa Henderson, Enterprise Manager Clinical Appeals and Denials
05 / THE IMPACT
A Scalable Model for Clinical Appeals
By combining experienced clinical denial professionals with purpose-built AI technology, WVU Medicine created a more scalable appeals process that increased productivity, reduced vendor dependence, strengthened staff performance, and improved financial outcomes.
AppealNavigator™ supports a broad range of denial types, including DRG revisions, medical necessity, outpatient coding, physician-level denials, and defense audits. Its role is to amplify clinical expertise, helping teams prepare policy-based, clinically justified arguments while keeping professionals involved in review and refinement.