Submitted-vs-Paid Variance Workbook

Eight Payers. One Hidden Variance. Most Teams Are Not Measuring It.

The submitted-vs-paid variance, by payer, in dollars.
SCHEDULE A DEMOSPEAK TO AN EXPERT
Downcoded claims are paid claims at the wrong price — invisible to the denial dashboard. This workbook surfaces the variance by payer, in dollars, with appeals attached.
Get the Workbook
Enter Work Email
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
What's Inside the Workbook.
Seven tabs, built to be used in sequence. Open the calculator monthly. Reference the matrix quarterly. Customize the templates per appeal. The scorecard tells you where you stand.
Where denials stem from
60% to 70% of denials stem from coding errors, CDI gaps, and payer rule violations that happen before the claim is submitted
The real cost of denial recovery
Rework, write-offs, and cash flow drag that most finance teams don't measure
A 3-step prevention framework
Diagnose root causes, intervene upstream, and measure financial impact
Implementation roadmap
what to do in Week 1 - 12 to shift from recovery to prevention
Sample ROI calculation
See how a mid sized hospital saves over $5M annually just by preventing 35% of denials
Variance Calculator
Enter trailing 3-month E/M counts by payer. Variance percentage, dollar impact, and risk flag compute live.
Run monthly.
Payer Risk Matrix
The six payers flagged for algorithmic downcoding - mechanism, status, appeal anchor, priority.
Reference quarterly.
Specialty Risk Map
Which specialties absorb the most downcoding pressure and the clinical pattern driving each one.
Use for specialty-specific assessments.
Appeal Templates
Three letters: Medicare Advantage, Cigna R49 commercial, portfolio-level pattern appeal. Citations pre-populated.
Customize per appeal.
Self-Audit Scorecard
Twelve questions, scored 1 to 5. Live interpretation panel maps the total to one of five readiness levels.
Run quarterly.
Sources & Change Log
Primary-source URLs for every claim in the workbook. Version history included.
Reference.
Download the Workbook
- WHY RAPIDCLAIMS

The Workbook Measures the Variance. RapidClaims Closes It.

The workbook measures the variance. RapidClaims closes it — validating every E/M claim against AMA 2021 MDM and time-based pathways, payer acceptance rules, and the documentation patterns algorithmic downcoders look for. By the time the claim reaches the payer, the code is defensible.
>98%
Coding Accuracy
AI-verified codes with complete documentation for every chart processed.
40%
Fewer Claim Denials
Pre-submission scrubbing catches coding errors before they reach payers.
170%
Coder Productivity Increase
Your coders focus on complex cases while AI handles routine volume at scale.
70%
Cost Savings
Eliminate overtime, temp staffing, and recruitment costs with scalable AI.
>98%
Clean Claim Rate
See how a mid sized hospital saves over $5M annually just by preventing 35% of denials
30%
Reduction in AR Days
Faster coding turnarounds unlock millions in accelerated cash flow.
>98%
Coding Accuracy
AI-verified codes with complete documentation for every chart processed.
40%
Fewer Claim Denials
Pre-submission scrubbing catches coding errors before they reach payers.
170%
Coder Productivity Increase
Your coders focus on complex cases while AI handles routine volume at scale.
70%
Cost Savings
Eliminate overtime, temp staffing, and recruitment costs with scalable AI.
>98%
Clean Claim Rate
See how a mid sized hospital saves over $5M annually just by preventing 35% of denials
30%
Reduction in AR Days
Faster coding turnarounds unlock millions in accelerated cash flow.
Trusted by Leading Healthcare Organizations
Results You Can Trust
RapidClaims delivered what other vendors only promised. We've seen a 30% reduction in AR days within one quarter, unlocking $2.5M in accelerated cash flow. Their platform adapts to our specific workflows instead of forcing us to change our processes.
CFO, Major Health System
$2.5M
Accelerated cash flow
30%
Reduction in AR days
RapidRisk transformed our value-based care documentation, improving RAF by 15% and reducing documentation gaps by 22%. This directly impacts our shared savings and quality metrics.
Medical Director, Leading Accountable Care Organization
15%
↑ RAF
45%
New conditions identified
"With RapidClaims, we're maximizing our limited resources while improving revenue capture by 5%. Our team now spends more time on patient care and less on administrative tasks."
Director HIM, Federally Qualified Health Center
5%
↑ increased revenue
40%
Reduction in coding and billing costs
Our clean claim rate jumped from 92% to 99% with a 96% first pass yield rate. With RapidClaims, we improved the productivity of our coding staff by 100%. Our team only focuses on complex cases that require human expertise.
VP Revenue Cycle, Multi-Specialty Physician Group
27%
Reduction in claim denials
70%
Reduction in cost to collect
RapidRisk transformed our value-based care documentation, improving RAF by 15% and reducing documentation gaps by 22%. This directly impacts our shared savings and quality metrics.
Medical Director, Leading Accountable Care Organization
15%
↑ RAF
45%
New conditions identified
RapidClaims delivered what other vendors only promised. We've seen a 30% reduction in AR days within one quarter, unlocking $2.5M in accelerated cash flow. Their platform adapts to our specific workflows instead of forcing us to change our processes.
CFO, Major Health System
$2.5M
Accelerated cash flow
30%
Reduction in AR days
Our Platform Integrates with 
All Major EHR and PM Systems
RECOGNISED BY :
PRODUCTS
RapidCode
RapidScrub
RapidCDI
SOLUTIONS
For types of customers
For types of roles
For types of use cases
Resources
Blogs
Case Studies
News
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Address
115 Broadway, New York, NY 10006, United States
Email sales@rapidclaims.ai
© 2025 RapidClaims. All rights reserved.
Terms of ServicePrivacy PolicyCookie Policy