Denials prevented, appeals won and rework capacity returned.
For health system CFOs, revenue cycle and operations leaders. Values prevention and recovery at net reimbursement — not billed charges — so the case survives finance review.
Your inputs
Benchmarks show typical enterprise ranges — override every field with your own numbers.
Benchmark: 500k–3M for a multi-site health system
Collectable amount, not billed charges
Benchmark: $350–$900 depending on payer and service mix
Benchmark: 8–12% is the common enterprise band
Coding, eligibility, authorisation and registration errors AI can catch
Benchmark: 30–50% of initial denials
Benchmark: 45–65% on appealed claims
Better evidence assembly and payer-specific argument structure
Benchmark: 8–15 points
Benchmark: 25–45 minutes end-to-end
Benchmark: $32–$48 in US health systems
Used to value the working-capital benefit of faster rework
Benchmark: 40–55 days
Prevented denials, incremental appeal wins, rework capacity returned and the carrying value of faster cash.
Directional estimate. Prevented denials are valued at expected collection, not billed charges. Assumes 45% of denial rework is automatable in the expected case, 3.5 days of A/R recovered at a 6% cost of capital, and a $750k programme investment.
Illustrative estimate only. This calculator models the inputs and assumptions you enter; it is not an audit, valuation, quotation or proposal, and the figures are not a guarantee of results. Actual outcomes depend on scope, data quality, platform configuration and change management. Validate anything material with a Pronix delivery lead before making a decision.
Three-scenario view
Finance reviewers expect a range. These scenarios flex adoption and implementation cost around the model you entered.
Slower adoption, higher integration effort
Your inputs as entered
Strong sponsorship, clean data, phased scale-up
Want a quote built on these numbers?
Send us the brief and a delivery lead validates these assumptions against your data, then replies with indicative scope, timeline and commercial options.
CalculatorDenials prevented, appeals won and rework capacity returned. — routed to this team
How enterprise leaders use this model
- Where does AI actually reduce denials?
- Three places. Pre-submission edits catch coding and eligibility errors before the claim leaves. Denial classification routes the appealable ones to the right worklist instead of a queue. Drafted appeal letters with the clinical evidence attached lift win rates on the ones worth fighting. The first is prevention, the other two are recovery.
- Why value write-offs rather than billed charges?
- Billed charges overstate everything. A prevented denial is worth its expected collectable amount, and a won appeal is worth the net reimbursement minus the cost of working it. This model uses average reimbursement per claim, not gross charges, so the number survives a CFO review.
- What denial rate should we compare against?
- Initial denial rates commonly run 8–12% of claims, with roughly two-thirds of denials technically appealable but under half actually appealed because of rework capacity. That gap between appealable and appealed is usually the largest recoverable pool.
- How does this affect days in A/R?
- Faster classification and drafted appeals shorten the rework cycle, which pulls cash forward. This model values that separately as a working-capital benefit at your cost of capital — it is real, but it is one-time, so it should not be reported as recurring savings.
What is the ROI of AI in revenue cycle denials management?
Denials AI value is claims corrected before submission so the denial never happens, appeal win-rate lift on those that do, rework capacity returned to the follow-up team, and cash pulled forward through shorter A/R days — all valued at net reimbursement rather than billed charges.
Ungated — results appear instantly, no email required.
What you enter
- Annual claim volume and denial rate
- Average net reimbursement per claim
- Share of denials preventable at submission (%)
- Current and improved appeal win rate
- Rework cost per denied claim and A/R days improvement
How it is calculated
- 1.Calculate today's denied claim volume and the net revenue exposed.
- 2.Apply the pre-submission prevention rate to remove denials at source.
- 3.Apply the appeal win-rate lift to remaining denials.
- 4.Value rework hours returned at loaded follow-up cost.
- 5.Value the A/R days improvement as a working-capital benefit, then subtract investment.
What you get back
- Net revenue recovered annually
- Denials prevented and appeals won
- Rework capacity returned
- Cash-flow impact from A/R days
Built for: Revenue cycle, finance and RCM operations leaders at health systems and physician groups.
Is preventing a denial worth more than winning an appeal?
Materially more. A prevented denial costs nothing to work and carries no write-off risk, while a won appeal still consumes staff time and delays cash by weeks.
Why value denials at net reimbursement rather than billed charges?
Billed charges are not collectable revenue. Contracted rates, adjustments and payer mix mean net reimbursement is the only figure a CFO will accept in the model.