Behind every claim denial is a patient waiting for treatment. Behind every coding error is a practice losing revenue it earned. Behind every prior authorization delay is a physician spending hours on the phone instead of seeing patients. Arbiter RCM fights for every dollar so clinicians can fight for every patient.
Healthcare is the only industry where the provider delivers the service, documents it, codes it, submits the bill — and then the payer decides whether to pay. And increasingly, payers are deploying their own AI systems to review and deny claims in seconds, at scale, with an efficiency that manual provider workflows cannot match. The result is an asymmetric arms race: payers get faster at saying no, while providers are still fighting denials with spreadsheets and phone calls. Arbiter RCM levels the battlefield.
Arbiter RCM is not a billing tool. It is a revenue intelligence platform that uses AI to code autonomously, predict denials before submission, automate prior authorizations, verify eligibility in real time, scrub every claim against payer-specific rules, recover denied revenue through intelligent appeals, detect underpayments against contracted rates, and give patients transparent, understandable financial information before they receive care. It transforms the revenue cycle from a reactive cost center into a proactive, self-improving financial engine.
Arbiter RCM intervenes at every stage where revenue is lost.
Arbiter RCM integrates with your EHR, practice management system, and clearinghouse to create an end-to-end revenue intelligence layer.
Autonomous coding is the single highest-impact AI application in revenue cycle management. Arbiter RCM's NLP engine reads clinical documentation — physician notes, operative reports, discharge summaries — and generates accurate CPT, ICD-10, and HCPCS codes without human intervention for routine encounters. The system handles specialty-specific nuances, modifier requirements, and documentation specificity standards. For complex cases, the system pre-populates codes for human review, reducing coder workload by 40% while improving accuracy and time-to-submission.
The most valuable denial is the one that never happens. Arbiter RCM analyzes historical claims data, payer behavior patterns, and current claim characteristics to predict denial probability before submission. High-risk claims are flagged and routed for human review — enabling correction of missing documentation, modifier errors, medical necessity gaps, and eligibility issues before the claim ever reaches the payer. The system learns continuously from denial outcomes, improving prediction accuracy with every cycle.
Prior authorization is the single most despised administrative process in healthcare — and for good reason. It delays patient care, consumes physician time, and denies treatments that have already been clinically determined to be necessary. Arbiter RCM automates the entire PA workflow: determining whether PA is required (per payer, per plan, per procedure), assembling supporting documentation from the EHR, submitting PA requests electronically, tracking approval status, and alerting the clinical team to expirations before scheduled procedures. The system reduces PA turnaround from days to hours.
The front desk is where revenue is won or lost. Arbiter RCM verifies insurance eligibility, coverage details, coordination of benefits, and patient demographics in real time — at scheduling, at check-in, and again before service delivery. The system cross-references multiple data sources to validate active coverage, identify secondary insurance, detect plan changes, and flag patients with coverage gaps. Every eligibility error caught at the front desk is a denial prevented six weeks later.
Every claim passes through Arbiter RCM's multi-layered scrubbing engine before submission. The system validates against CMS NCCI edits, MUE limits, LCD/NCD medical necessity requirements, payer-specific contract terms, modifier rules, place-of-service requirements, and diagnosis-procedure linkage. Claims that fail any validation rule are flagged with the specific error, the recommended correction, and the denial code that would have resulted — enabling the billing team to fix the claim in minutes rather than appealing a denial in weeks.
When denials do occur, Arbiter RCM automates the appeal process: categorizing the denial by type and root cause, assembling clinical documentation and medical necessity evidence from the EHR, generating payer-specific appeal letters with appropriate regulatory citations, and tracking appeal outcomes to optimize future argumentation strategies. The system prioritizes appeals by expected recovery value — ensuring high-value denials are worked first and no recoverable revenue is abandoned.
Payers do not always pay the contracted rate — and most providers lack the systems to catch it. Arbiter RCM compares every payment against the provider's payer contracts, fee schedules, and expected reimbursement calculations, flagging underpayments for automatic dispute. The system also analyzes zero-balance accounts that appear resolved but contain hidden payment variances, recovering revenue that would otherwise be written off permanently. Contract compliance monitoring ensures that payer behavior matches contractual commitments across every claim, every code, and every service line.
The rise of high-deductible health plans has shifted billions in financial responsibility to patients who cannot predict their costs. Arbiter RCM provides real-time, patient-specific cost estimates before service delivery — accounting for insurance benefits, deductible status, copay/coinsurance obligations, and out-of-pocket maximums. The system generates clear, understandable financial summaries, offers personalized payment plan options, predicts patient payment likelihood, and enables financial counselors to have transparent conversations that improve collections while preserving the patient relationship.
Results from our deployed revenue cycle programs.
Arbiter RCM was deployed across 12 hospitals and 340 employed physicians. The predictive denial engine scored every claim before submission, routing 18% for human review. First-pass denial rate dropped from 14% to 6%. The appeals engine recovered $2.4M from previously abandoned denials. Underpayment detection recovered an additional $1.8M. Autonomous coding reduced DNFB by 50% and coding costs by $500K. Total first-year revenue impact: $8.2M.
A 22-physician orthopedic practice deployed Arbiter RCM's prior authorization engine. PA turnaround time dropped from 4.2 business days to 4 hours. PA-related surgical delays decreased 78%. Physicians recovered 60 hours per week of clinical time previously spent on PA paperwork. PA denials dropped 22%. The practice's surgical volume increased 12% — not because demand grew, but because the administrative barrier to scheduling was eliminated.
A federally qualified health center serving 28,000 patients — 60% Medicaid, 15% uninsured — was operating at a 2% margin with denial rates above 18%. Arbiter RCM's eligibility engine identified active Medicaid coverage for 1,400 patients previously billed as self-pay. Denial rates dropped to 7%. Clean claim rate improved from 76% to 95%. The health center's operating margin improved from 2% to 8.4% — the difference between survival and closure. The clinic used the additional revenue to hire three new physicians and expand hours.
I became a doctor to take care of patients. Instead, I was spending 14 hours a week on prior authorization phone calls — arguing with insurance company employees who had never examined my patient about whether the surgery I recommended was "medically necessary." Arbiter RCM gave me those 14 hours back. My patients get their surgeries faster. I see more patients. And I no longer go home wondering why I went to medical school.
We are a safety-net clinic. Our patients are Medicaid, uninsured, underinsured — the people nobody else wants to see. Our margin was 2%. We were six months from closing. Arbiter RCM found Medicaid coverage for 1,400 patients we had been billing as self-pay. It cut our denials in half. It improved our clean claim rate from 76% to 95%. Our margin is now 8.4%. We hired three new doctors. We extended evening hours. That technology didn't just save our revenue. It saved access to care for 28,000 people who have nowhere else to go.
The underpayment detection engine found $1.8 million that our payers owed us and never paid. Not denied claims — paid claims. Claims that were paid below the contracted rate and posted as complete. Without AI contract compliance monitoring, that money would have stayed in the payer's pocket forever. We now audit every payment, automatically, against every contract term. The payers have noticed.
Schedule a demonstration of Arbiter RCM — configured for your practice, your payer mix, and your revenue goals.