Independent revenue recovery review · UAE clinics
We review claims your current process has already handled, identify recoverable denials, short-payments and write-offs, and pursue the ones worth recovering.
Your team, RCM provider and systems stay unchanged.
Historical claims, denials and payments.
Performance fee on verified incremental collections.
A read-only export of historical claims, denials, remittances and resubmission history. No integration project, no access to your live systems, and nothing for your billers to learn or adopt.
The baseline is agreed in writing before any work starts, and we separate genuine recovery from ordinary growth, price changes and volume shifts. Insurer payments continue going directly to you.
Databases, processing, model inference and backups all sit in-country on infrastructure we control. Claims data is never sent to a public AI service.
One ledger. What appears recoverable, what it is worth, and the evidence behind each line. You read this before deciding whether to continue.
| What we found | Potential recovery |
|---|---|
| Denials never worked | AED 508k |
| Claims paid short | AED 292k |
| Filing-window risk | AED 220k |
| Repeat preventable rejections | AED 164k |
| Other | AED 57k |
| Total | AED 1.24m |
| What we found | Claims | Gross exposure | Est. recovery rate | Potential recovery |
|---|---|---|---|---|
| Denials never worked | 634 | 820,000 | 62% | 508,000 |
| Claims paid short | 411 | 530,000 | 55% | 292,000 |
| Filing-window risk | 192 | 310,000 | 71% | 220,000 |
| Repeat preventable rejections | 286 | 245,000 | 67% | 164,000 |
| Other | 173 | 190,000 | 30% | 57,000 |
| Total | 1,696 | 2,095,000 | — | 1,241,000 |
Assumptions. Recovery rates shown are estimates, not predictions. Short-payment variance is directly observable from remittances. Appeal-success rates depend on payer, denial reason and how much of the filing window remains — and on a first review they are informed assumptions, stated as such. Figures above describe a 12-month window of 4,412 claims and do not describe any specific clinic.
Because “processed” does not always mean “fully collected.”
A denied claim is visible. A short-paid claim may simply be marked paid and closed.
An appeal may be technically possible but not economical for a human team to investigate.
A repeated payer pattern may only become obvious across hundreds of claims.
We do not assume your team made mistakes. We apply a second analytical pass to transactions that already moved through the normal process.
A claim is billed at AED 4,800 and reimbursed at AED 4,100. The payment posts, the claim is marked complete, and the file closes.
The remaining AED 700 never becomes a task, because nothing in the process has a reason to raise one. Claim by claim it is invisible. Across four hundred claims with the same payer and procedure family, it is a contract conversation.
A billing operation is measured on throughput and has to serve the whole workflow. A review has one job and can spend its attention on closed and low-probability cases that would never justify a person’s time individually.
Most proposals ask you to switch provider, migrate systems, retrain staff and hope. This one asks for a copy of claims you have already submitted.
We do not bid for their scope, touch their workflow or report on their staff. Their contract and their fee are unchanged.
No new software to learn and no queue to adopt. We independently review the financial outcome after the normal billing process has done its job.
Our fee comes out of collections that arrive after — and because of — our work, measured against a baseline agreed in writing first.
Five recurring patterns. None of them imply anyone did anything wrong — each is a consequence of how normal billing operations are measured and prioritised.
Billed AED 4,800, reimbursed AED 4,100, marked complete. The AED 700 never becomes a task because the system has no reason to raise one.
Appeals are commonly worked in the order they arrived rather than by what they are worth. High-value recoverable claims can expire while low-yield items are cleared.
Invisible claim by claim, unmistakable across four hundred. One payer reimbursing 4.8% under contracted terms on a single procedure family is a contract conversation, not a billing one.
Every payer runs a submission window. Claims sitting three weeks from that deadline are the most time-sensitive money in your ledger.
One missing field or code pairing, recurring across a specialty. Recovering it once is cash; identifying the pattern stops the bleed.
Every figure traces to named claims with the denial letter or remittance advice attached. You can hand it to your provider and ask them to disagree.
Your billing operation and this review are answering different questions. That is the whole basis for doing both.
| Existing billing / RCM | Second·Opinion |
|---|---|
| Runs the revenue cycle | Audits the financial outcome |
| Processes active work | Re-examines completed and unresolved outcomes |
| Optimises workflow throughput | Prioritises expected recoverable AED |
| Works inside its own process | Independently reviews the result |
| Sees a claim as paid, denied or open | Asks whether the economic outcome was optimal |
| Must serve the full workflow | Can focus only on high-value anomalies |
| Measures operational KPIs | Measures verified incremental cash |
Software reviews the entire claim population. People make the final judgement.
A human team cannot economically investigate every closed or low-probability case. Software can screen the complete population and escalate only the financially meaningful anomalies.
Every claim in the export is scored, not a sample. Most return nothing and are never surfaced. What reaches a human is the set where the expected value of investigating clears the cost of doing it.
Patterns are learned payer by payer and specialty by specialty, rather than averaged into a single generic rule.
An eligibility denial from one payer may be routinely recoverable with an employer letter attached, while the same denial reason from another payer rarely reverses at all. Averaging those two into one number makes both predictions useless.
A high-probability AED 15,000 recovery should not wait behind a low-probability AED 200 claim simply because it entered the queue first.
recovery probability × amount recoverable − intervention cost
Every open item carries all three terms, so the queue is ordered by what it is worth pursuing rather than by age or by who called most recently. This is also why a performance fee is viable for us at all.
The claim, payment, denial reason and supporting evidence stay attached to the recommendation.
A single line reads: claim reference, payer, billed and paid amounts, denial code and reason text, the comparable historical cases behind the estimate, the amount at stake, and the filing days remaining. Your authorised staff approve or reject it.
We never alter a clinical record, never invent a service and never upcode. Coding responsibility stays with your authorised staff.
A rules engine handles deterministic checks — code validity, required fields, filing windows, contract terms. Statistical models estimate recovery probability and flag payment anomalies. Language models read unstructured documents and prepare case files.
A person reviews before anything is filed. The models prioritise; people decide.
No seat licence, no per-claim charge and no monthly retainer. Two line items, and only one of them is large.
| Component | When it is charged | Amount |
|---|---|---|
| Onboarding fee | Once, for data preparation and the leakage review | AED 10k–25k |
| Performance fee | Only on incremental collections attributable to our work | Agreed % of uplift |
| If we recover nothing | — | AED 0 |
A performance fee is only honest if both sides know what “extra” means. Before any work begins we fix the baseline in writing: historical collection rate, denial and recovery rates, payer and procedure mix, the measurement window, and which claims are excluded.
We then separate genuine recovery from ordinary growth, price effects, volume effects and mix effects, so the invoice is never an argument about attribution. Where a slice of eligible claims is deliberately left unworked as a control, that is agreed up front and used to evidence the difference our work made.
UAE law restricts the transfer, storage and processing of health data generated here to inside the country. We treat that as an architectural requirement rather than a policy paragraph.
Databases, processing and model inference all run in a UAE region on infrastructure we control, and backups stay in-country. The scoring models run on our own hardware, so claims data is never sent to a third-party AI service. Access is read-only wherever possible and named only, with a complete audit trail of every record opened and every decision taken.
We do not start by taking over your revenue cycle. One payer, one specialty or one denial category — small enough to prove, large enough to matter.
Read-only. No integration project.
See exactly what appears recoverable before deciding whether to continue.
Define what counts as incremental cash before we touch anything.
Your authorised team approves filings.
No performance recovery means no performance fee.
The proposition
We will tell you in three weeks, with your own numbers. If the answer is “not much”, that is a genuinely useful thing to know and you owe us nothing further.