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Empowering Scalable Performance Excellence with Reliable AI & Automation Solutions

SCALE Healthcare’s AI-powered solutions prevent denials, automate front-desk operations, and maximize revenue through intelligent documentation and coding—saving healthcare providers millions annually.

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Agentic AI Technology

Revolutionary AI Solutions

DenialShield:

  • Flags high-risk claims & suggests corrections before submission
  • Auto-generates appeal letters & resubmits after denials
  • Continuously learns from payer behavior & adapts
Value Creation Opportunity
- 77% of providers reported increased denials in 2024
- ~$260B in annual denial costs (20% ↑ in 5 years)
- $43.84 avg rework cost per denied claim

Key Product Features:

  • Agentic AI pre- & post-denial agents with learning loop
  • Real-time claim monitoring & rule adaptation
  • Massive reduction in preventable errors (~46%)
Claims Analytics Dashboard Top Risk Factors by Volume Missing Prior Auth Duplicate Claims Incorrect Coding Eligibility Issues Timely Filing 0 1000 2000 3000 3200 AI Insights High denial rate for modifier -25 34% Denial rate Flag high-risk modifiers for manual review Claims pending > 45 days 1,400 Aged Claims Auto-assign to follow-up agents Top Denial Reasons Appealed Appeals Other (4%) Duplicate Claims (28%) Medical Necessity (6%) Missing patient info (10%) Prior Auth missing (22%) Non Covered service (12%) Timely Filing exceeded (18%) Performance vs Industry Benchmarks Metrics Your Value Industry Avg Performance Denial Rate 6.4% 9.8% Excellent Appeal Success rate 78% 65% Good Days to Resolution 15 days 21 days Excellent Cost per Claim $12.5 $18.75 Excellent ROI% 276% 195% Excellent

FrontDesk Shield:

  • Automates registration, eligibility verification, and prior auth
  • Captures demographic and insurance data accurately
  • Improves scheduling and pre-visit counseling
Value Creation Opportunity
- $18B surge in admin spend from 2021–2022
- 79% cite denials as top RCM issue
- Labor costs up 5.4% YoY

Key Product Features:

  • Modular agents for every front-desk task
  • Orchestration layer for seamless operations
  • Continuously adapts from payer outcomes

FrontDesk AI Assistant

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RevenueShield:

  • ChartAI prompts for complete documentation inside the EHR
  • AutoCoder AI generates codes with rationale & confidence scores
Value Creation Opportunity
- 70% of notes lack CPT/ICD specificity
- Coders spend 20–30% on data retrieval
- Manual coding errors = 15–20%

Key Product Features:

  • Explainable NLP-driven coding with audit trails
  • Full clinical-coder control with override options
  • Proven: Increased coding accuracy
RevenueShield AI Clean Claim Rate Trend Jan Feb Mar Apr May Jun Jul Quarterly Claims Value ($M) Q3 24 Q4 24 Q1 25 Q2 25 $594.8M Annual Revenue Generated Performance Highlights 99.7% Clean Claim Rate 192 Days Zero Backlog 17% UHG Efficiency Gain 53% Other Paper Optimization

A Modular, Agentic AI Architecture

Specialized AI agents working together as focused experts for critical RCM tasks, combining to form powerful AI products on the unified Scale RCM Optimizer Platform

Unified Platform

Scale RCM Optimizer Enterprise-grade foundation with single login, unified analytics, and complete security

DenialShield AI

Proactive denial defense & automation

Pre-Denial Agent

Risk prediction & prevention

Post-Denial Agent

Appeal automation & resolution

FrontDesk AI

Front-end automation & verification

Eligibility Agent

Real-time coverage verification

Prior Auth Agent

Automated authorization management

RevenueShield AI

Documentation & coding excellence

ChartAI Agent

Documentation optimization

AutoCoder Agent

AI-driven accurate coding

Choosing the Right Tech Partner

SCALE+

MSO Focused

Exclusively MSO-focused. 100% of our investment is dedicated to the needs, challenges, and growth of MSOs.

Trusted & Proven

Proven track record delivering practical, high-impact solutions to leading national MSO operators across 600+ engagements. Culture of delivering precisely relevant substance over lofty, unrealized marketing promises.

Holistic Approach

Comprehensive portfolio of: High impact technology solutions, Managed services, Consulting. Leverage the right solution & deployment model to meet your organization's precise needs.

Typical Vendors In The Market

Hospital-Centric

Most large technology vendors focus on hospitals, not MSOs, leading to misaligned tools and support.

Unproven Entrants

Many new technology solution providers lack real-world healthcare market experience & success. Often heavy on marketing promises with wide variance on actual execution delivery.

Narrow Solutions

Many technology solution providers offer narrow point solutions, no complementary services for holistic performance success + practical development & testing of tech solutions. Workflow solutions that optimize outdated RCM workflows vs. support MSOs in adopting transformative AI-driven automation.

600+
ENGAGEMENTS
100%
MSO FOCUSED
AI
POWERED

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