Unlocking Hidden Revenue in the Era of AI-Driven Payer Reviews
AI-Assisted Revenue Recovery & Claims Audit Solutions
- $100M+
- Claims identified
- 5–15%
- Recoverable
Payers Are Getting Smarter.
Providers Are Losing More Revenue.
AI is reshaping how payers review and reimburse claims, creating new challenges for providers navigating an increasingly complex reimbursement landscape
The AI Advantage for Payers
- Automating adjudication at scale
- Flagging claim inconsistencies faster
- Systematically reducing payouts
The Impact on Providers
- Rising denial rates
- More aggressive claim scrutiny
- Growing volume of underpayments
Revenue leakage is increasing, but it rarely shows up on a dashboard. Most of it sits quietly in claims that are never revisited.
Why This Matters Now
Internal teams are optimized for current RCM workflows, not historical audits. Most organizations stop revisiting claims after 90–120 days, leaving 6–18 months of claims largely untouchedResult: revenue loss with no clear owner or recovery processes
of net revenue lost annually to RCM leakage
of practices name denials as their #1 leakage source
of denied or underpaid claims remain recoverable
A Dedicated Model for Historical Claims Recovery
We combine deep healthcare operations expertise with AI-assisted workflows and specialized audit methodologies to recover missed revenue — without disrupting your existing processes
Our Approach
- 01Audit 6–18 months of historical claims
- 02Identify incorrect denials & underpayments
- 03Execute rework, appeals, and payer follow-ups
- 04Support settlement and revenue recovery
Delivered as a parallel workflow with minimal lift from your internal teams
in improperly denied claims identified for potential recovery through arbitration, across four hospital groups
How We Are Different
Not traditional RCM. Not just analytics.
Human expertise + AI-assisted execution, validated by domain experts
Focus on missed revenue recovery, not just process efficiency
Ability to go deep into historical claims data
Outcome-aligned approach tied to recovery potential
Where Our Solutions Work Best
- Provider groups with high denial rates or write-offs
- Organizations undergoing growth or consolidation
- Practices with provider turnover
- Teams with limited bandwidth to revisit older claims
A Low-Friction Model, Built Around Outcomes
- No disruption to existing RCM workflows
- Minimal internal effort required
- Structured onboarding with defined audit scope
- Ongoing visibility into findings and recoveries
Extended Capabilities
Additional support is available to address broader revenue and operational priorities:
Is There Revenue Sitting in Your Past Claims?
We'd be happy to run a high-level assessment, share benchmarks from similar provider groups, and identify potential recovery opportunities