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.
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
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.