Notes
Notes from the build
What we are learning while building AI denial recovery: the economics, the data problems, and the engineering.
August 11, 2026
The denial spike was scheduled
CMS put NCCI PTP edit version 32.0 into effect on January 1: over 2.4 million edit records, refreshed every quarter. Your Q1 bundling denials were on the calendar.
August 10, 2026
Denial management is a data problem before it is a staffing problem
The top denial causes are all data failures decided before submission. Appeals teams win the argument afterward; they cannot prevent it. Why hiring cannot fix the denial rate.
August 7, 2026
Fighting denials costs providers $70 million a day
US hospitals spent $25.7 billion contesting denied claims in 2023, and 70% of contested denials were eventually overturned. Who pays for the error.
August 7, 2026
The write-off threshold: the math that kills small denials
Every billing company has a number below which denied claims are not worth fighting. Where that number comes from, and what moves it.
August 7, 2026
Why we built a 750-case synthetic claims testbed before touching real data
You cannot develop on PHI and you cannot evaluate without answer keys. Our fix: synthetic transaction chains with planted defects and a simulated payer.
August 7, 2026
Denials are nine problems, not one
A duplicate denial and a medical-necessity denial have nothing in common. Why we run separate pipelines per denial group, and what the volume data says.