AI Claim Scrubbing Tools for Physician Practices and Clean Claim Rate Impact
Practices with clean claim rates in the 70s-80s are leaving thousands monthly on the table.
Marcus Delgado-Wren
RCM Technology Editor
Marcus Delgado-Wren
Marcus Delgado-Wren has covered healthcare IT and revenue cycle infrastructure since the early days of ICD-10 transition, drawing on a prior career as an implementation consultant for mid-market health systems. His reporting focuses on the vendor landscape and the operational realities of deploying new billing platforms.
7 stories
AI Fraud Detection Models and False Positive Denial Rates for Independent Practices
AI models flag legitimate claims as fraud because they lack practice-specific context.
Marcus Delgado-Wren
Denial Overturn Rates by Payer and Appeal Level
Most denied claims get overturned on appeal, if providers fight them.
Marcus Delgado-Wren
Timely Filing Denial Trends and Payer Deadline Discrepancies
Payers use conflicting deadlines that leave no room for appeals or fixes once they pass.
Marcus Delgado-Wren
Bundling and Unbundling Denial Patterns in Surgical and Procedural Claims
Standard NCCI edits mask a repeatable pattern that maps to predictable code pairs and payer rules.
Marcus Delgado-Wren
Commercial Payer Denial Rates by Specialty in 2024 and 2025
Denial rates now depend on specialty, payer mix, and algorithmic behavior.
Marcus Delgado-Wren
AI-Generated Prior Authorization Denials and the eviCore and Cohere Health Models
How two AI vendors control prior authorization denials across American healthcare.
Marcus Delgado-Wren