ASP-RCM Denial Prediction. Stop the denial before the claim leaves your system.
A claim denied is a claim that costs real money to rework, and often never gets collected. The ASP-RCM denial prediction model scores every claim against payer-specific patterns and flags avoidable denials before submission.
The capabilities, spelled out.
No black boxes. Here’s exactly what this layer does, end to end.
Pre-submission denial prediction
Scores every claim before it transmits.
Payer-specific rule learning
Learns each payer's denial patterns over time.
Documentation completeness check
Flags missing modifiers, NDCs, units.
Auth & medical necessity validation
Cross-checks against payer policy bulletins.
Fix-suggestion engine
Tells the biller exactly what to fix, not just "denied likely."
Continuous retraining on 835 outcomes
Model improves as payers change rules.
Capabilities, in plain language.
From event to outcome.
A real picture of the workflow. Not a marketing diagram.
Claim built in EHR
Charge entered, codes assigned.
Predictor scores claim
Risk score by denial reason category.
Above threshold?
Held for biller review with fix suggestion.
Biller fixes & releases
Common: add modifier, attach docs, fix POS.
Retrained on outcome
835 result feeds back to model.
Regional health system, Southwest.
Pairs well with.
Each layer of the AI stack reinforces the next. Denial Prediction AI compounds when paired with these.
Ready to see Denial Prediction AI on your data?
We’ll run a 30-day analysis on a sample of your claims and show you what would have been recovered, denied, or flagged. No obligation.