Revenue cycle operations, re-architected for AI
We turn the AI across your revenue cycle into compounding outcomes—the operating system, engineered and run with you to the cash.
Compounding RCM domain intelligence
600+ provider organizations run revenue cycle with us
- $1.5B annual cash uplift for clients
- 900+ payer-specific denial playbooks encoded
- 50 AI efficiency pathways across access, integrity, and resolve
Why IT Matters NOW
Turning Intelligence into RCM outcomes
Think of an AI agent as a surgeon. Brilliant in isolation, but outcomes depend on the operating room around them: the instruments, the patient record, and the live monitors. AI now reaches every corner of the revenue cycle. The challenge is building that operating room. That's the operating system: the memory, rules, and live signals that turn scattered AI into RCM outcomes you can measure.
Adoption isn’t the gap
63%
of organizations already use AI in RCM
AI is adopted; outcomes lag. A capable tool in isolation produces a one-time result. Harnessing it for outcomes takes an operating system that remembers, applies the rules, and learns from every claim.
Oliver Wyman, April 2026
Denials
$43B
Denials are won upstream, not in the appeal queue
41% of providers now run denial rates of 10% or higher. The value is preventing them at eligibility, registration and coding—connecting the front of the cycle to the back.
AHA, Costs of Caring 2026
The fixed window
Jan 2027
Real-time, FHIR-native, on a deadline
Prior auth goes real-time and FHIR-native across every payer interaction. The operating system built now is what makes the deadline a non-event.
CMS, Interoperability and Prior Authorization Final Rule (CMS-0057-F)
We don't add another tool. We re-architect the revenue cycle for AI and run it, so intelligence operates.
Proof in production
Real outcomes, inside real health systems
AI-and-automation-led revenue cycle, run to the number—across 600+ provider organizations, from critical-access hospitals to large health systems and physician groups.
End-to-end RCM | 600+ providers
AI-led revenue cycle, at scale
Revenue cycle run end-to-end with AI and automation across hospitals, health systems, physician practices and billing companies—patient access through cash collection.
90%+ of engagements run on success-fee commercials—we bill for the result, not the build.
$1.5B
annual cash uplift for clients
+44%
monthly cash collections
60%
lower cost-to-collect
Operations intelligence | Leading US health system
Process mining that found the leakage
A leading US health system (>$11.2B net patient revenue, 3,800+ beds, ~53 clinics) had aging AR, high denials, and no end-to-end view of the claim lifecycle. Process-mining operations intelligence gave real-time visibility, surfaced the bottlenecks and rework loops, and predicted at-risk claims before they denied.
10% lower cost-to-collect | 37% faster first-touch | +2% net collections.
47%
faster claim filing cycle
40%
lower denial rate
~$900K
recovered in 6 months
Claims & Denials | RCC Resolve™
Denials prevented; recovery compounded
Pre-submission sensing closes the upstream gaps, and payer-behavior memory plus payer-specific appeal playbooks lift recovery—this is where the outcomes-linked commercial lives.
<3.5% cost-to-collect | outcomes-linked commercials once the baseline is set.
<7%
initial denial rate
44%
recovery lift on denied claims
>97%
net collection rate
Kairos the operating system
The operating system that turns intelligence into outcomes
It's the operating room around your agents: the harness, context, and sensors that give every AI system the memory, rules, and live signals it needs to act with the full picture, turning a capable agent into one that continuously compounds intelligence.
The operating system is the asset; agents change. Every claim and denial teaches the harness, so each new generation of AI inherits the intelligence you've already built.
The operating system is the asset; agents change. Every claim and denial teaches the harness, so each new generation of AI inherits the intelligence you've already built.
05
AI-native operations: Agents
Run revenue cycle agents for coding, claims, prior authorization, and patient messaging using your systems, your tools, or ours.
Varies by client
04
Domain Intelligence: Domain Harness
The Domain Harness encodes what should happen through more than 900 payer-specific denial playbooks, coding guidelines for inpatient, outpatient, emergency department, and professional fee services, and HIPAA, OIG, and CMS guardrails. These are deployed as executable skills and promoted only after passing quality gates.
Core · compounds
03
Organizational context: Intelligent Context Framework (ICF)
The ICF captures what happened by carrying patient journey, claim history, and payer behavior across every interaction. It preserves decision traces and peer benchmarks in real time.
Core · compounds
02
Operations intelligence: Sensors
Operations Intelligence captures what's happening in flight through process mining, conversation intelligence, and document intelligence. It flags denial risk, eligibility drift, and rework loops before they cost you.
Core · compounds
01
Systems of Record
Your EHR and core systems are connected through FHIR, HL7, and X12 within your cloud, including your VPC, IAM, and data residency requirements. They are read from, not replaced.
Varies by client
What we engineer for providers
From the EHR to the cash—the whole revenue cycle, connected
Where we put technology to work across the revenue cycle — each powered by a Tech Services capability, and each behind a provider solution you can run.
EHR & systems-of-record integration
FHIR R4 | HL7 v2 | X12 | runs in your VPC
We connect your EHR and core systems—and the AI across them—into one operating system that runs inside your cloud, so nothing lives in a silo.
Systems, application and data engineering
Operations intelligence & sensors
doc intelligence on charts, EOBs, 835/837
We use process, task, conversation, knowledge and document intelligence to read denial triggers, eligibility drift and should-vs-did gaps in flight, so risk is caught before the claim leaves the queue.
Sensor and operations intelligence
RCM decision intelligence
900+ payer playbooks | IP/OP/ED/ProFee
We encode 900+ payer-specific denial playbooks, coding guidelines and compliance guardrails as executable skills your agents inherit on day one.
Domain harness engineering
Agentic RCM workflows
patient access → coding → claims → denials
We orchestrate eligibility, prior authorization, coding assist, denial classification and auto-appeals across specialist agents and humans end to end, so AI works inside the workflow, not beside it.
Agentic orchestration
The provider solutions this powers
The technology above runs behind our provider revenue-cycle solutions. Explore the ones built for your operation:
Patient Access
Revenue Recovery
Revenue Integrity
Coding & CDI
Denials Management
Consulting & Advisory
Where the value compounds
50 AI efficiency pathways, from access to resolution
The added value shows up as cross-module pathways—each one connecting a signal in one stage of the revenue cycle to a better decision in the next. Together they span patient access, revenue integrity and resolution, and every pathway compounds as the environment learns.
Denial prevention | 10 pathways
FHIR R4 | HL7 v2 | X12 · runs in your VPC
Front-end and mid-cycle signals stop denials before they happen—eligibility, prior auth, registration quality and coding accuracy feeding denial prevention downstream.
Revenue integrity | 10 pathways
+3–5% Case Mix Index | >96% clean claim | >98% coding compliance
CDI, coding, charge and audit reinforce each other—cleaner claims, complete charge capture and compliant coding, with leakage stopped before the bill goes out.
Process automation | 12 pathways
−40% verification time | <35 A/R days | >99% demographic accuracy
Sequential cross-module automation from scheduling through claims—verification, eligibility, registration and A/R handled straight-through.
Continuous improvement | 10 pathways
>20% coding-denial reduction | self-correcting auth & eligibility
The compounding flywheel—what denials and recovery learn flows back to update eligibility, auth and coding rules upstream, so the operation self-corrects.
Patient financial experience | 8 pathways
+25%–30% self-pay collections | >12% bad-debt liquidation
Propensity, charity screening, counseling and pre-service outreach route each patient to the right financial path—bad debt avoided at source, not chased later.
Trust & Compliance
Governed autonomy. By design.
Autonomous AI in the revenue cycle is only as trustworthy as the governance around it. Compliance, accountability, and transparency are architected into the operating system from the start, not bolted on after deployment. Every agent action, regardless of who built the agent, operates under the same rules.
HIPAA · HITECH
.svg?tr=f-auto)
SOC 2 Type 2
.svg?tr=f-auto)
ISO 27001
HITRUST
OIG · CMS · 501(r)
Compliance, architected in
Rules at the moment of action
Every agent action is governed by HIPAA, OIG, CMS, TCPA and 501(r)—applied at execution time inside the workflow, with patient data handled under HIPAA/HITECH and your data-residency controls at every layer.
Decision traceability
Audit-ready by design
Decision traces log every action, actor and piece of evidence, and every AI recommendation surfaces the reasoning and data that drove it—reconstructable for an auditor, by design.
Progressive trust
Autonomy that’s earned
Work shifts from humans doing it, to humans overseeing it, to running autonomously, only once trust and performance are proven, with skills promoted to production after passing eval thresholds.
full-stack operator
Intelligence That Operates
Where it starts
RCM diagnostic
Most engagements start with a discovery workshop that frames the value at stake across the revenue cycle before anything is built.
Explore consulting services
The signal
Sensor and operations intelligence
The process mining and document intelligence that flag denial risk and eligibility drift before the claim leaves the queue—the signal behind every next-best action.
Explore the capability
How WE Engage
Transform, implement, and operate
We design, build and operate agentic revenue-cycle operations as a single motion—and put commercial skin in the game, not just delivery SLAs.
Good questions to start with
How is this different from the AI already in our systems, or a point tool?
We don’t compete at the agent layer. The agents in your systems—and any point tool—do the task; we build the operating system around them: the harness that applies payer-specific rules, the context that carries memory across the claim, and the sensors that feed every outcome back. That’s what makes a capable agent a compounding one, across the operations a single agent never sees—and every new agent you adopt walks into intelligence you’ve already built.
How do we start without disruption?
A 4-week engagement, read-only and parallel-run—no write-back to your systems, no PMO load, out of the implementation team’s critical path. It captures a clean operations baseline, designs the operating system on your real workflows, and ends with a 90-day roadmap and a CFO-ready commercial model. Fixed fee, creditable to what comes next.
How do you keep AI in the revenue cycle compliant?
Governance is architected in, not bolted on. Every agent action runs under HIPAA, OIG, CMS, TCPA and 501(r) at execution time; decision traces are audit-ready by design; and agents earn autonomy progressively, promoted to production only after passing eval thresholds.
Do you build the AI models yourselves?
We don’t build foundation models from scratch. We select, fine-tune and evaluate domain models on your data—the coding, denial and propensity models behind the work—as your data services partner (see AI Data Services), and orchestrate the models you already run inside the operating system.
What does an AI operating system mean for the revenue cycle?
It means your coding, denials and patient-access agents act on one patient-and-account context, your encoded payer rules, and live signals—run to the cash, not as disconnected tools. That’s what lets AI run the revenue cycle dependably and compound as your own intelligence.
INSIGHTS
Latest from the Firstsource team
Insights from the field, real operations, real outcomes, and perspectives from the people making it work in live operations.
CONTACT US
See where AI changes your cost and risk first
Start with a diagnostic across mortgage, lending, cards and fraud. We’ll frame the value at stake—and the first operation to re-architect—before you commit to anything further.