Diseñando SolucionesDiseñando Soluciones
WhatsApp
AI denial response · For IPS and providers

Fewer denials.
More revenue.

We answer every denial at your provider with automated processes and AI, following what each EPS, insurer or ADRES requires, with expert review and on time.

Free assessment on WhatsAppSee how it works

Monthly fee based on your volume · Success-based receivables: if we don't recover, we don't charge.

  • Each payer's requirements
  • Expert review
  • Zero load on your team
AI · SO
Denial case fileGL-2026-0417
Illustrative
SO

Missing documentation

Payer
EPS · Contributory
Amount denied
COP 18,420,000
  3. 03Correction
  4. 04
  5. 05
Response deadline
4 business days
Payer requirementsFormatRecordsChannel
  • Clinical evidence attached · Res. 2284/2023
  • Medical auditor's response, ready to file
StatusReady for settlement
Years in healthcare
14+
In denials managed
COP 1.5 T
In receivables recovered
COP 50 B+
Unanswered denials
30% → 3%
The problem

How much money is your provider leaving on the table?

01

Returned invoices

Missing evidence or malformed RIPS files block payment.

02

Unanswered denials

They expire without a response and are accepted by default.

03

Aging receivables

90 to 360 days without collection, harder to recover each month.

Complex cases we do take on
  • Medical necessity
  • Rates and contracts
  • Upheld denials
  • Late denials
  • Settlement meetings
  • ADRES · SOAT · ARL
The full cycle

From denial to payment: we cover the whole cycle.

Denial response, settlement and receivables recovery in seven stages; what we learn goes back to your billing.

Tap any stage to see the details

  1. The problem
    They arrive through several channels and the clock runs unchecked.
    What we do
    We centralize every return and denial with its invoice, records and deadline.
    Result
    No deadline runs unchecked.
    Assess this stage
The core of the service · Stage 3

How we respond to every denial.

This is how we handle stage 3 of the cycle, from arrival to closure: AI speeds things up, an expert writes the response.

  1. 01Automated

    Receive

    We read the denial wherever it comes from: portal, email, PDF or Excel.

  2. 02AI

    Classify

    Identifies the code and concept under Res. 2284/2023.

  3. 03Automated

    Fit the payer

    Applies that EPS, insurer or ADRES's rules: format, records, deadline and channel.

  4. 04Expert

    Respond

    A medical auditor or lawyer writes the response with clinical and regulatory support.

  5. 05Automated

    Check records

    Cross-checks records (MIPRES, RDA, payer portal) before sending.

  6. 06Automated

    File and track

    Filing through the payer's channel and deadline alerts until closure.

AI handles the repetitive work; our experts make the calls.

See how it would work for my provider
Requirements by payer

We know every payer from the inside.

Every EPS, insurer and ADRES has its own platform, rules and requirements. We know them and respond the way each one asks.

  • We receive your denial

    Whether it comes from the portal, email or file of each EPS, insurer or ADRES.

  • We know their platform

    We work in each payer's portal and upload format.

  • We know their rules

    Res. 2284/2023 for EPS and ARL; SOAT and ADRES follow their own claims procedure.

  • We tailor the response

    With the format, records and deadline that payer requires.

Example: a records denial from a contributory-regime EPS

Illustrative
  1. Day 1

    Arrives through the EPS portal

  2. Classified

    SO (records)

  3. That EPS's requirement

    Discharge summary + authorization in a single PDF

  4. Response

    The medical auditor responds

  5. Day 9

    Filed on day 9 of 15 available

Response deadline
9 of 15 business days· 6 days to spare

EPS under intervention or in liquidation? The route switches to creditor claims: see stage 6 of the cycle.

Comparison

Your in-house team vs. Diseñando Soluciones.

  • Cost

    Fixed payroll, turnover and trainingPredictable monthly fee based on your volume

  • Deadlines

    Deadlines slip throughAlerts and on-time responses

  • Clinical judgment

    Billing staff without medical supportMedical auditor on every denial

  • Settlement

    Your team alone against the payerLawyer and auditor at the table

  • Overdue receivables

    Manual follow-up, no agingManaged by aging and priority

  • Legal collection

    Hire a separate lawyerSame team, success-based

Does your provider have unanswered denials? We review your case at no cost and tell you how much you can recover.

Get my free assessmentSee plans
Why us

The whole process, without loading your team.

Zero load on your team

We classify, respond, file and settle. Your team just receives reports.

Interdisciplinary team

Every denial has a clinical, a technical and a legal side.

  • Medical auditors
  • Head nurses
  • Lawyers
  • Billing analysts
  • Data engineers

AI + experts

Automation removes repetitive work and missed deadlines; clinical and legal judgment always comes from our experts.

TestimonialsExample

What providers say.

  • −70% overdue denialsExample
    “We had denials months overdue. Within a quarter they were up to date, without slowing billing.”
    General manager
    Level-2 provider · Antioquia
    Contributory EPS
  • 82% denials reversedExample
    “They took on the medical-necessity denials nobody wanted to touch, and we backed them up in settlement.”
    Receivables coordinator
    High-complexity clinic · Bogotá
    Contributory and subsidized EPS
  • 360+ day receivables recoveredExample
    “We recovered high-cost drug receivables we had already written off.”
    Finance director
    Oncology provider · Valle del Cauca
    ADRES
  • −45% returnsExample
    “The feedback changed how we bill. Today we have almost no returns.”
    Billing lead
    Outpatient network · Caribbean coast
    Subsidized EPS
  • 0 in-house hoursExample
    “Our team spends no hours on denials. We just review the monthly report.”
    Administrative manager
    Clinical laboratory · Santander
    Contributory EPS
  • 100% on timeExample
    “Not a single denial has expired since. Every one goes out within the legal deadline.”
    Medical accounts coordinator
    Mental health provider · Coffee Region
    Subsidized EPS
  • +38% SOAT collectionsExample
    “With SOAT and ARL, evidence is everything, and every response arrives complete and traceable.”
    Finance director
    Orthopedic clinic · Cali
    SOAT and ARL
  • 3× faster responsesExample
    “Automatic classification showed us within days where our money was leaking.”
    General manager
    Home care provider · Barranquilla
    Subsidized EPS
  • Predictable feeExample
    “The monthly fee is clear, and on receivables we only pay when the money is recovered.”
    Receivables lead
    Maternal-child clinic · Boyacá
    Contributory EPS
  • −60% upheld denialsExample
    “We came to settlement with every denial backed up. That changed the negotiation.”
    Deputy finance manager
    Level-3 provider · Tolima
    Subsidized EPS and ADRES

1 of 10

Plans

A monthly plan sized to your volume.

Denial response for a monthly fee. Overdue receivables and legal collection, success-based only.

What sets the price of your plan?
  • Number of denied invoices
  • Service type (outpatient, emergency, inpatient, high-cost, SOAT)
  • Denied amount

  • Essential

    Up to 300 denied invoices per month

    For small providers or a single service.

    • Multichannel denial intake
    • AI classification (Res. 2284)
    • Responses written by experts
    • Filing and deadline alerts
    • Monthly management report
    Quoted in the assessmentGet a quote for this plan

  • Professional

    Recommended

    301 to 1,500 denied invoices per month

    For mid-size providers working with several EPS.

    • Everything in Essential
    • Support at settlement meetings
    • Feedback report to billing
    • Assigned coordinator
    Quoted in the assessmentGet a quote for this plan

  • Comprehensive

    Over 1,500 invoices or custom

    For high-complexity clinics and networks.

    • Everything in Professional
    • Dedicated team
    • Root-cause analysis with your billing team
    • Custom service levels
    Quoted in the assessmentGet a quote for this plan

In every planOverdue receivables and legal collection success-based: if we don't recover, we don't charge.

FAQ

What providers ask about denials and receivables.

Another question? Message us on WhatsApp.

  • A glosa is the payer's objection to part or all of an invoice already filed; a return (devolución) rejects the whole invoice before processing. With EPS, adapted entities and ARL (health component), both are governed by Resolution 2284 of 2023 (Single Manual). SOAT and ADRES handle claims through their own procedure, which we also manage.

  • Three concrete things: 1) it reads each denial, whether it comes from a portal, a PDF or an Excel file, and classifies it by Res. 2284/2023 code and concept; 2) it applies each EPS, insurer or ADRES's rules: format, records, deadline and filing channel; 3) it tracks deadlines with alerts and automates filing and records cross-checks (MIPRES, RDA, EPS portal). The AI does not write the responses: our experts, medical auditors, lawyers and analysts, write and sign them.

  • Always within the legal deadline. In the relationship with EPS and ARL, Law 1438 of 2011 (art. 57) gives the provider 15 business days to respond; SOAT and ADRES follow their own procedure. We track every deadline with automatic alerts and prioritize by amount and date.

  • No. Claims for traffic accidents (SOAT) and catastrophic events (ADRES) have their own procedure, different from Resolution 2284 of 2023. We build each claim with its records and answer objections through the route that applies.

  • Yes. Filed invoices that go unpaid, settled denials with no payment or aging receivables: we manage them by aging, with administrative, pre-legal and, if needed, legal collection.

  • The collection route changes: receivables must be filed as a creditor claim within the liquidation process, with supporting evidence. We audit every invoice, file the claim with support and follow up until it is recognized.

  • It depends on the service line. Denial response is billed as a monthly fee based on your plan, set by the number of denied invoices per month, the type of service (outpatient, emergency, inpatient, high-cost, SOAT) and the denied amount. Overdue receivables and legal collection are success-based: a percentage only on what is actually recovered; if we don't recover, we don't charge. We quote both after the free assessment.

  • Very little. We only need access to denials, invoices and records. We classify, respond, file, settle and collect; your team receives reports.

  • Success-based receivables
    If we don't recover, we don't charge.
  • Confidentiality first
    Signed agreement before we see a single record.
  • Within the legal deadline
    Every response goes out before it expires.

Book your free assessment.

We review your denials and show you how much you can recover.

Message us on WhatsAppNo cost · No commitment
german@disenandosoluciones.com316 877 6348
or leave your details
Full billing cycle

Want to prevent denials at the source?

Beyond responding to them, we support your provider’s entire billing cycle: contracting, FEV-RIPS, SIIFA and claim filing.

Explore Healthcare Solutions