Customer Success Story
AI-Powered Denial Management Drives Faster Reimbursements for a National ASC Network
- Organization: National Ambulatory Surgery Center (ASC) Network
- Locations: 150+ ASCs Across 30 States
- Annual Revenue: $2.5 Billion
- Challenge: High volume of claim denials, lengthy appeals, and revenue delays impacting operational efficiency
- Objective: Reduce denials, automate appeals, and improve revenue cycle performance
The Challenge
A national ASC network faced mounting revenue cycle challenges, with denial rates surpassing 18% and appeal resolution times exceeding 55 days. Given the high procedural volume and complex payer mix, manual denial management was slow, resource-intensive, and prone to errors.
Key issues included:
- High denial rates due to medical necessity, coding, and documentation errors
- Slow, labor-intensive appeals that strained staff resources
- Lack of real-time payer insights, leading to inconsistent reimbursement outcomes
- Revenue delays impacting operational cash flow
With rising costs and increasing payer scrutiny, the ASC network needed an AI-powered denial management solution that could:
✅ Reduce preventable denials before submission
✅ Automate the appeals process for faster resolution
✅ Optimize claim recovery workflows with smart prioritization
✅ Enhance payer intelligence for better reimbursement predictability
The Solution
TSI’s AI-Powered Denial Management
TSI implemented its AI-driven denial prevention and appeal automation solution, seamlessly integrating with the ASC network’s EHR and RCM platforms. The solution delivered:
✔ AI-Driven Denial Prevention – Predictive analytics identified high-risk claims and corrected errors pre-submission, preventing 35% of avoidable denials.
✔ Automated Appeals Submission – AI-generated, payer-specific appeal letters were instantly created and submitted, increasing overturn rates by 50%.
✔ Intelligent Workflow Prioritization – AI ranked denials by recovery probability, ensuring the highest-value claims were addressed first, reducing appeal resolution time by 58%.
✔ Real-Time Payer Intelligence – AI continuously learned from payer responses, automatically adjusting denial prevention strategies and improving first-pass claim acceptance rates by 30%.
✔ Seamless Integration & Zero Disruptions – The solution was deployed without disrupting existing workflows, requiring no additional IT lift.
Results & Impact
📉 Denials Prevented: 35% reduction in avoidable denials
📈 Appeal Success Rate: 50% increase in overturned denials
📉 Resolution Time: 58% reduction in denial appeal turnaround time (from 55 to 23 days)
📉 Administrative Burden: 40% decrease in manual appeal processing
💰 Revenue Impact: $21M in accelerated reimbursements within 12 months
"TSI’s AI-powered denial management has transformed how we handle claims. We’ve drastically cut down our denials, accelerated appeals, and significantly improved cash flow. This solution allows our team to focus on higher-value tasks while AI handles the complexities of claim recovery."
- Revenue Cycle Director, National ASC Network
Conclusion
AI-Powered Denial Management, Stronger Revenue Performance
By leveraging TSI’s AI-driven denial management, this national ASC network reduced denials, automated appeals, and optimized revenue cycle efficiency—without increasing administrative workload.
🔹 Let’s talk. Contact TSI today to see how AI can improve your ASC network’s reimbursement performance.
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