Revenue cycle and patient access are measured on denial rates and days in A/R. But the true cost of resolving a patient inquiry, authorization, or billing dispute is 2-5x higher than the per-contact metric suggests — hidden inside rework loops, callback chains, and coding escalation. As AI agents move into authorizations and patient billing, we independently verify whether they lowered the true cost of a resolved case, or simply automated the rework at machine speed.
Prior authorization requests that require 2-4 follow-up calls to payers before resolution. Each callback adds $12-18 in agent time and 1-3 days in cycle time, but is logged as a separate contact.
Denied claims that cycle through rework queues 2-3 times before appeal or write-off. The rework cost often exceeds the original claim value, but is buried in aggregate denial rates.
Complex coding questions that escalate from patient access to billing to clinical coding and back. Each handoff adds cost and error risk. Resolution takes 5-10 touches across 3+ departments.
Three of 16 fault lines the verdict grades. See the full method →
Did the AI work?
Would not hold
An authorization like this would post as “resolved” — then bounce back for a third payer callback.
True cost to resolve
~$96
reported: $24
Fault attribution
Data
✗
Model
✓
Operator
✓
Handoff
✗
On a failure like this, fault would land on the input data and the payer-callback handoff — sound model call, correct operator steps, broken on incomplete authorization data. Not the coder’s work.
Figures are illustrative and conditional. On your engagement they’re produced from your de-identified data and labeled accordingly.
De-identified CSV exports from your RCM platform and telephony system. No API integration is required for the initial read; healthcare data handling and BAA requirements are scoped in writing where applicable.
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A scoped pilot on one use case, with concrete give/get terms — you help define the first independent verdict in your vertical, and get the read before anyone else has it.
Bring your volume, FCR, and cost — no PHI — and get your own true-CPR exposure. A founder-led Findings Call walks you through it.
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