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At-risk revenue pushed toward resolution
Reduction in claim follow-up time
Status work completed without staff touch
A multi-state hospital network was managing claim status and denial follow-up across a fragmented payer landscape, with RCM staff moving between payer portals, IVR lines, internal billing systems, and work queues. With initial denial rates running near 12–14%, thousands of claims required repeated status checks and payer-specific follow-up before payment could move forward.
The broken point was operational friction. Staff were not only reviewing denied or delayed claims; they were manually logging into portals, waiting through IVR paths, interpreting inconsistent payer responses, updating notes, and deciding the next action claim by claim. This created a high-cost workflow where skilled revenue cycle teams spent 45+ minutes per inquiry on repeatable administrative work.
The business impact showed up as delayed collections, rising cost-to-collect, and unworked AR that stayed idle while staff chased payer information. Leadership needed to protect cash flow and increase follow-up capacity without adding headcount, making autonomous RCM execution a near-term priority.
Novacis Digital delivered Agentic AI (autonomous workflow agents) as an execution layer for provider revenue cycle operations, automating claim status checks, denial follow-up, and payer follow-through across payer portals, IVR systems, and internal RCM queues.
The agents interpret claim context, payer requirements, denial codes, aging status, and worklist priority before taking action. They complete repeatable payer interactions, document outcomes, assign next steps, and escalate only the claims that need staff review.
The differentiation is the revenue cycle context layer: agents do not just click through screens; they apply payer-specific follow-up rules, claim-value prioritization, denial handling logic, and audit-ready action tracking.
Governance is built into the workflow through role-based review queues, confidence thresholds, exception triggers, and full activity logs for compliance and operational oversight.
Shifts the operating model from staff-led status checking to agent-led execution with human validation on exceptions.
Autonomous RCM Capabilities
Payer Execution Features
Novacis Digital deployed the production pilot in 8 weeks across two regions and six priority payers, targeting claim status checks, denial follow-up, and payer follow-through tied to aged AR. Over the next 12 weeks, the program expanded to 14 payers and five hospital markets, with agents completing routine payer interactions, documenting outcomes, and escalating claims that required staff judgment. Early wins included faster claim movement, lower manual inquiry volume, and quicker identification of payer-side blockers.
The results tied directly back to the Business Challenge: staff were no longer spending the majority of follow-up time navigating payer channels, and unworked AR began moving into active resolution pathways.
Aged AR advanced into active follow-up across priority claims — Financial impact: high-value claims were moved out of idle work queues and into payer action paths without adding manual inquiry cycles.
17.5 days removed from average payer follow-through lag — Time impact: idle time between status check, documentation, and next action was reduced across the scale-up window.
14 priority payers brought into governed execution — Strategic impact: payer-specific rules for status, denial, escalation, and exception routing were standardized across regions.
28,000 payer interactions completed — Execution proof: interactions were completed across the first scale-up window with structured notes and evidence capture.
19 FTE-equivalent capacity protected annually — Ops impact: staff capacity was redirected from repeatable payer navigation to exception handling, denial resolution, and recovery work.
