Agentic AI for RCM
Automate Claims, Denials, Eligibility, and Documentation at Scale
Grow your billing operation without adding headcount. AI automates verification, claim scrubbing, coding support, and denials.
The Bottleneck: Manual RCM Processes Limit Growth
RCM companies face operational inefficiencies that cut margins and slow throughput:
Eligibility errors cause 30–40% of claim denials
Manual verification misses coverage issues, leading to costly rejections and rework.
Manual claim scrubbing is slow and inconsistent
Human review can't catch every error, resulting in delayed payments and reduced clean claim rates.
Coders waste time chasing provider documentation
Missing or incomplete documentation creates bottlenecks in the coding and billing workflow.
Denial management is reactive, not preventative
Teams spend time fixing denials instead of preventing them, impacting revenue cycle efficiency.
Scaling requires hiring more billers—often impossible
Growing client base demands more staff, but hiring and training costs are prohibitive.
Clients demand faster turnaround and transparency
Manual processes can't keep up with client expectations for real-time updates and faster payments.
How Agentic AI Streamlines the Entire Revenue Cycle
Automate the most critical and time-consuming RCM workflows
Automated Eligibility & Benefits Verification
- Real-time checks across major payers
- Summaries formatted for billers
- Detects inactive plans, missing coverage, mismatched details
AI Claim Scrubbing & Data Validation
- Catches coding errors, missing modifiers, invalid combinations
- Applies payer-specific rules before submission
- Improves clean-claim rate and reduces rework
Documentation Extraction & Coding Support
- Pulls necessary encounter info from provider notes
- Creates coding-ready summaries for teams
- Speeds up charge entry & coding review
Denial Prevention & Automated Appeals
- Identifies denial patterns
- Drafts appeal letters and gathers supporting documentation
- Tracks deadlines and payer rules
ROI of Agentic AI for Billing & RCM Companies
Transform operations, increase margins, and scale without adding headcount
reduction in manual verification, scrubbing, and follow-up work
improvement in first-pass acceptance
denials = faster payments & higher collections
to new clients without hiring
profitability per FTE