06/09/2026
Start With the Happy Path, Not Denials, To Start Your Agentic Journey towards a Touch-less Revenue Cycle
The transformational opportunities using AI, especially when combined with a structured and enriched metadata set, to finally move from reactive, 'dead dashboards' to interrogative, 'management by curiosity' are real, they are here and in many ways, paralyzing.
Strong RMC and Healthcare Finance leaders have always managed by asking business questions, the principle is not new. The speed to knowledge (and subsequent speed to value driven action) is the new thing. I can ask my Merlin Intelligence goblin crisp business questions, using years of deep subject matter expertise and it answers me with remarkable insight!
Our industry is abuzz with an obsession on Denial Prevention (as it should be, it, along with stealth underpayments and Bad Debt are the top Net Revenue killers) using AI for detection, counter maneuvers to the Payer's new war chest of AI Denials, and rapid rote appeals drafting. I would suggest this is the wrong place to start the Agentic Journey. Instead, start with 'what goes right?'
For 16 years, Excalibur has measured CWOT (Closed Without a Touch) and PWOT (Paid Without a Touch) so that we understand what % of claims, at a Payer and Service Type level of granularity, paid or resolve completely sans any human intervention. These are powerful Leading Indicators that guide data-driven staffing models and ongoing feedback loop reporting to the front-end. But now the technologist finally exists for the original intent of the KLPI. We can study every single 'happy path' claim where the Payers behaved, the Merlin Intelligence goblin tell you exactly what is common about the 1000 claims, or 1Mill claims, that were a touch-free success (I.e. scheduled vs walk-in, single auth requirement procedures, demographic, same day surgery, Gov vs Non-Gov etc).
Then, having the power of a PWOT model that constantly teaches itself, simply exclude accounts from tempting a PAR to spend $2.40 of your cost to collect on a superfluous touch in their archaic workqueue.
The analytics begotten of this are endless as inevitably the Payers will move the goal post and claims that did PWOT 6 months ago will suddenly start stalling or denying; and the AI will know it, and flag it for your Analytics and workflow.
This is how the transition starts from the Reps working 1000 claims with oodles (my favorite data driven accounting term) of needless touches to attacking the 75 that need critical thinking skills, energy, and human intervention.
Excalibur is building a Touch-less (not Touchless) Revenue Cycle and are very excited to help our client and vendor collaborator community with this quest!
Dr. Zane Newitt
