DenialShield Pro
10/10
Demand Score
Medicare Advantage denial rates have increased 50% in recent years, with practices losing $50,000-200,000 annually to preventable denials. Each denied claim costs $25-118 to rework.
7/10
Blue Ocean
Competition Level
$299-499
Price/Month
Predicted customer spend
60 days
Time to MVP
Difficulty: Hard
The Problem
“Denials are piling up. And regulatory pressure isn’t slowing down — from the surge in Medicare Advantage audits to the rollout of the V28 risk adjustment model, which eliminates thousands of codes and demands far greater specificity. Each gap in documentation, each missed pre-authorization, each unplanned readmission represents revenue slipping away.”
🔗 Validated by Real User Complaints
This problem has been verified through 1 real user complaints:
Competitor Landscape
- Cotiviti - enterprise-focused, extremely expensive
- Change Healthcare - complex implementation, overkill for smaller practices
- Availity - focuses on eligibility, not denial prevention
- Waystar - broad platform, not specialized in Medicare Advantage
Must-Have Features for MVP
V28 model compliance checker
Pre-submission denial risk scoring
Automated documentation gap identification
One-click documentation request system
Real-time CMS update integration
⚠️ Potential Challenges
- Keeping up with constantly changing CMS regulations
- HIPAA compliance requirements
- Integration with various EHR systems
- Building trust in healthcare market
Risk Level: Moderate
🎯 Keys to Success
- Demonstrable reduction in denial rates within 30 days
- White-glove onboarding support
- Integration with top 3 EHR systems
- Regular compliance update webinars
Ready to Build This?
This hard-difficulty project could be your next micro-SaaS success.