Veradigm brings AI to revenue cycle management: fewer denials, faster cash, lighter admin load
Veradigm is using artificial intelligence to improve revenue cycle performance in healthcare. The focus is simple: cut claim denials, speed up payments, and remove repetitive work. Its Payerpath platform is positioned to streamline core workflows and reduce friction across the claim lifecycle.
This push builds on earlier moves, including an AI tool for EHR-integrated messaging and efforts to move EHR processes toward paperless operations. The throughline is clear-embed intelligence into everyday work so staff can spend more time on care and high-value tasks.
Why this matters for operators
Margins are tight, hiring is hard, and payer rules keep shifting. AI that improves first-pass acceptance and trims pointless touches can directly impact days in A/R and cost-to-collect.
The opportunity is big: the industry still spends billions on administrative tasks that could be automated or simplified. See the CAQH Index for a macro view of waste and automation potential here.
What Payerpath could change day to day
- Upfront checks: eligibility, prior auth cues, coding edits, and documentation prompts before the claim goes out.
- Claim scrubbing: rules-based and model-driven edits that catch issues likely to trigger denials.
- Status automation: auto-follow-ups and payer status checks to reduce manual calls and portals.
- Appeals triage: templates and suggested language based on denial reason and payer behavior.
- Workqueue prioritization: route the right claim to the right person at the right time.
How to evaluate and implement
- Define the business case up front: target a specific denial type, payer mix, or specialty. Start small.
- Baseline before go-live: first-pass acceptance, denial rate by category, days in A/R, touches per claim.
- Pilot with one service line and one payer first. Expand only after you see sustained lift.
- Map data flows with your EHR and clearinghouse. Close gaps on eligibility, auth, and remit codes.
- Set a feedback loop: weekly reviews of false positives/negatives and quick rule updates.
- Train in short bursts: 15-minute sessions tied to the exact workflow the team uses daily.
- Lock in vendor SLAs for uptime, response times, and model updates that address payer rule changes.
Guardrails you need
Protect PHI and keep access tight. Confirm encryption in transit and at rest, and restrict data to the minimum needed for the task.
Document decision logic for edits and denials so staff can explain actions and override when necessary. Keep a manual fallback for edge cases. For privacy and security requirements, review HHS guidance on the HIPAA Security Rule here.
Metrics to watch
- First-pass acceptance rate
- Overall denial rate and top denial reasons
- Days in A/R and aging by payer
- Clean claim rate
- Cost-to-collect (labor and fees)
- Staff touches per claim
- Appeal overturn rate
- Avoidable write-offs
Beyond RCM
Veradigm's strategy extends across clinical workflows, from EHR messaging to paperless document flows. The pattern: make administrative steps lighter and let clinical teams work with less friction.
If the RCM gains hold, expect spillover into prior auth support, referral management, and patient communications-anything repeatable, rules-heavy, and measurable.
Action checklist
- Pick a denial category with clear ROI (e.g., medical necessity or eligibility).
- Set three KPIs and lock the baseline.
- Run a 60-90 day pilot with weekly checkpoints.
- Codify what worked into SOPs and scale.
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