Healthcare AI ROI calculator and worked examples.
Healthcare AI ROI depends on three numbers: your claim volume, your current cost per claim, and the percentage improvement the AI delivers. This page walks through the calculation for the most common AI use cases, with worked examples by practice size.
Definition.
ROI for healthcare AI investments is the net annual cash benefit (cost savings + revenue recovery) minus the annual program cost, divided by the program cost. Programs with 12-month ROI under 3x typically need rework or replacement.
Key points.
Eligibility verification AI ROI
Cost per manual eligibility check: $3-8 (CAQH). Cost per automated: $0.20-1.00. At 100,000 visits per year, automation saves $200K-$700K annually plus the front-end denial reduction (typically 5-15 percent of front-end denial dollars).
Prior authorization AI ROI
Cost per manual PA: $14-26 (CAQH). Cost per automated: $4-8. At 10,000 PAs per year, automation saves $100K-$220K plus cycle-time compression value (faster access to care, reduced patient leakage).
Autonomous coding ROI
Coder cost per encounter: $4-12 depending on specialty. AI cost per encounter: $0.50-3. At 100,000 encounters per year and 80% straight-through coding, savings are $280K-$720K plus reduced denial rate value.
Denial prediction ROI
Cost of post-submission denial: $25-118 per denial (MGMA). Cost of pre-submission rework: $5 per claim. At 10% baseline denial rate dropping to 6%, on 100,000 claims, that is 4,000 fewer post-submission denials. Net savings: $80K-$450K annually.
Insurance discovery ROI
Recovery rate: 5-15 percent of self-pay AR converts to insurance-billable. At $2M self-pay AR, that is $100K-$300K in recovered revenue against typically 15-25 percent contingency. Net recovered revenue: $75K-$240K annually.