Advancing AI Reasoning to Combat Medical Denials
R1 is working with NVIDIA to advance R1-super, a powerful reasoning model built for healthcare claims adjudication using NVIDIA Nemotron. Explore how R1 is tackling complex, long-horizon medical reasoning to improve performance, reduce costs and help lay the foundation for real-time claims adjudication at scale.
Areas of Focus
Redefining the frontiers of revenue cycle automation
Payer Policy Intelligence
Keeping up with payer policy changes requires the monitoring of tens of thousands of publications that affect whether claims will be accepted or denied. Our team is building agents that apply AI to monitor over 30,000 ongoing policy changes and over 20,000 proprietary billing rules to turn them into applied intelligence so that accuracy is guaranteed.
Coding Accuracy
Medical coding is a critical step in translating clinical language into the billing language that payers require. It’s an area where mistakes are costly. The R37 team is applying cutting-edge AI to autonomously code encounters combined with the diligence of our DRG-V safety net, industry expertise and depth of data & regulatory learnings. By bringing these areas together the team is moving towards full automation of the mid cycle.
Next-Generation Payer Contract Analysis
Improving net revenue begins by identifying the best possible payment for every service. Doing this at scale historically has required tedious contract analysis and financial modeling, but by leveraging cutting edge Large Language Models we are radically simplifying this process. This research area is helping R1 clients increase additional net revenue and capture more underpayments.
Clinical Denial Prevention
Clinical denials occur for a broad set of denial reasons and are a constant, costly challenge for providers. Our team is exploring the best ways to apply AI to automate the end-to-end workflow from denial receipt to appeal submission, as well as experiment with strategies that maximize overturn rates.
AI Enabled Contact Center
Hospital call centers interact with a high volume of callers daily. From appointment scheduling to insurance verification and denial follow up – each call represents an opportunity for greater efficiency. This research agenda is focused on A/B testing, refining voice flows for inbound and outbound calling, and performance benchmarking across millions of annual interactions.
Reasoning Models in RCM
Reasoning models are at the heart of RCM. Beyond pattern recognition, AI can make logical inferences about documentation, claims and reimbursement pathways. Within our lab, we’re exploring how these advanced reasoning models can drive smarter automation and decision support across the revenue cycle.
Approach
R37 identifies, builds and scales AI solutions that drive measurable impact across the revenue cycle.
( 1 )
We take a system-level approach to AI.
Unlike other solutions that stitch together disconnected applications, our system-level approach integrates and orchestrates AI agents across the entire revenue cycle. This provides seamless connectivity between different components and stages, delivering a faster, frictionless and more transparent financial experience for both providers and patients.
( 2 )
We are a team of distinguished engineers.
We have brought together category-defining operators and technologists to accelerate the pace of innovation in revenue cycle management. Building on two decades of solving real-world challenges, our skilled team is creating the agentic revenue cycle that the future demands.
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We bring experience at scale.
For over twenty years, we have pioneered revenue cycle automation and bring deep category expertise in payer-provider dynamics. Our unrivaled reach means that today we serve 95 of the top 100 US health systems. This uniquely positions us to create an improved revenue cycle that works better for all.
R37 Engineers
A dedicated team of distinguished engineers and technologists building enterprise-grade AI solutions
Mark Sithi
SVP, Product, R37 Lab
Steve Albert
Chief Product Officer
Our Inspiration
Inspired by a game-changing moment in artificial intelligence
Move 37
R37 refers to the 37th move AlphaGo made in its second match against Go champion Lee Sedol. It was an unconventional move, unexpected even to experts, and changed how we understand both the game and AI. As the game progressed, the thrilling back and forth combination of humans and machine intelligence presented a new view of what the future could look like.
The R1 parallel
Our new approach to revenue cycle brings together advanced AI with deep domain expertise supported by human insight and brilliance. This powerful combination creates the opportunity to change the game once again on how revenue flows through the U.S. health system.
A bright future
At R37, we believe the future of AI and healthcare is about orchestrating AI and human expertise to work together to unlock superior financial outcomes for providers.
In Conversation
Meet the R37 leaders making the agentic revenue cycle a reality.
R37 Resources
Careers
We’re transforming the revenue cycle through advanced technology. Join us.
At R1 you can help deliver innovative solutions that revolutionize healthcare financial performance and create faster, more frictionless experiences for providers and patients.