Denials Reduced 28% with Predictive RCM Platform

Denials are a systemic drag on cash, people, and operations
They stall revenue, burn staff time on rework, and expose hidden failures in authorization, eligibility, coding, and documentation that must be fixed upstream—not chased downstream.
Predictive RCM is simply smart claim triage, not complex AI magic
It flags high-risk claims before submission, prioritizes appeals by recovery value, and continuously improves by learning from payer outcomes—shifting teams from firefighting to prevention.
Measured results prove the model works
Across 10 mid-size practices in six months: denials fell 28%, time-to-rebill dropped 42%, first-pass payments rose ~11%, and net collections increased ~14% through better data, routing, and accountability.
Five building blocks drive success—not the tool alone
Clean, mapped data; transparent risk scores with clear reasons; real workflows with SLAs; ROI-based appeal prioritization; and continuous feedback loops to refine rules and models.
Execution matters more than technology
Defined ownership, reason-based routing, short SLAs, automation where possible, and a Denial Review Board ensure changes stick and improvements compound over time.
ROI is fast and defensible
Recovering just 28% of denied dollars can generate payback in 6–9 months, with hundreds of thousands in net gains annually—making predictive RCM a financially practical, not speculative, investment.

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Denials are a systemic drag on cash, people, and operations
They stall revenue, burn staff time on rework, and expose hidden failures in authorization, eligibility, coding, and documentation that must be fixed upstream—not chased downstream.
Predictive RCM is simply smart claim triage, not complex AI magic
It flags high-risk claims before submission, prioritizes appeals by recovery value, and continuously improves by learning from payer outcomes—shifting teams from firefighting to prevention.
Measured results prove the model works
Across 10 mid-size practices in six months: denials fell 28%, time-to-rebill dropped 42%, first-pass payments rose ~11%, and net collections increased ~14% through better data, routing, and accountability.
Five building blocks drive success—not the tool alone
Clean, mapped data; transparent risk scores with clear reasons; real workflows with SLAs; ROI-based appeal prioritization; and continuous feedback loops to refine rules and models.
Execution matters more than technology
Defined ownership, reason-based routing, short SLAs, automation where possible, and a Denial Review Board ensure changes stick and improvements compound over time.
ROI is fast and defensible
Recovering just 28% of denied dollars can generate payback in 6–9 months, with hundreds of thousands in net gains annually—making predictive RCM a financially practical, not speculative, investment.