Stop Preventable Revenue Leakage Before Claims Go Out the Door
Decisive Connect helps healthcare providers move upstream from denial recovery to denial avoidance. The platform identifies missed charges, avoidable denial risk, underpayments, authorization mismatches, credentialing gaps, and utilization review risk while there is still time to act, triggering corrective workflows before reimbursement is delayed, appeals are created, or revenue is written off.
EHR
Source Signal
RCM
Source Signal
Claims & Remittances
Intelligence Training Signal
Payer Rules + Network
Source Content
Enrollment & Credentialing
Source Content
Connect source data into measurable trends.
Reveal denial insights, patterns, and risks.
Resolve current risks with directed action.
Embed intelligence upstream to prevent denials.
Coverage Risk Reduced
Revenue Integrity Outcome
Revenue Leakage Avoided
Revenue Integrity Outcome
Denials Prevented
Revenue Integrity Outcome
Receivables Preserved
Revenue Integrity Outcome
Move Revenue Protection Upstream
Reactive Denial Management Cannot Keep Up
By the time a denial appears, the care has already been delivered and the claim has already gone out. Teams are left chasing appeals, correcting claims, resubmitting work, and absorbing write-offs with manual processes that do not scale.
Avoid the Cost of Rework
Every denied claim creates operational drag: investigation, correction, resubmission, appeal tracking, delayed cash, and preventable labor. Decisive Connect focuses on resolving avoidable risk before it becomes downstream denial work.
Revenue Risk Starts Before Billing
Preventable leakage often begins in scheduling, registration, authorization, documentation, credentialing, charge capture, utilization review, and payer contract workflows.
Payers Are Using AI to Find New Denial Patterns
Payers are increasingly using AI and automation to identify new denial opportunities. Providers need to fight that with their own intelligence layer. Decisive Connect helps surface new payer-driven denial patterns as they appear, then turns those findings into governed workflows and automations that resolve the issue proactively before it becomes recurring revenue leakage.
Decision Support at the Source
Decisive Connect brings clinical and financial decision support into the workflows where risk is created, surfacing the right intervention while teams can still prevent delayed, reduced, or unreimbursed revenue.
Secure Data-at-Source Architecture
We evaluate data where it already resides whenever possible, reducing unnecessary replication while maintaining the security, auditability, and compliance controls healthcare workflows require.
Our SOC 2 Type II certification and HIPAA compliance program demonstrate our commitment to strong security and privacy controls for client data.
Automation Where It Fits, Human Review Where It Matters
Routine corrections can be automated, while complex exceptions can be routed to the right work queue, team, or reviewer with the context needed to resolve the issue quickly.
Priced Against the Value It Protects
Decisive Connect is designed to return a multiple of its cost through avoided denials, improved charge capture, underpayment detection, reduced manual work, and fewer unreimbursed receivables.
Revenue Leakage Assessment
Try before you commit with Rapid Connect.
Start with historical claims and remittance data to estimate the value Decisive Connect could bring before committing to a broader subscription or license. The assessment shows where denials are happening, what patterns are driving reimbursement leakage, and which automation opportunities can produce the fastest measurable ROI by preventing repeat denials before future claims are submitted.
Powered by Rapid Connect
A lean assessment before full implementation
The assessment consumes provider claims and remittance history, runs it through Decisive Connect AI based insights and pattern matching, and presents a clear view of denial contributors currently impacting revenue cycle performance and reimbursement of AR. The goal is to identify which historical denial patterns can be corrected upstream so the same issues do not become new denied claims, resubmissions, or appeals.
Outcome
A denials and revenue leakage dashboard showing the overall denial situation, the highest-impact preventable patterns, and the gross revenue exposure that could be avoided through Decisive Connect automations before claims go out the door.
View the Denial Avoidance FlowDenials / Revenue Leakage Dashboard
Automation Opportunity View
Potentially avoidable exposure
$3.9M
Total denials
12,480
Denied gross revenue
$8.6M
Automation candidates
46%
Illustrative sample based on a trailing 12-month claims and remittance assessment. Actual denial volume, gross revenue exposure, and automation opportunity vary by provider, payer mix, service lines, and data quality.
Connect historical data
Claims and remittance history are ingested through Rapid Connect without a heavy upfront integration project.
Reveal leakage patterns
AI based insights identify denial contributors, recurring patterns, payer trends, and revenue leakage drivers.
Quantify automation ROI
The assessment identifies denial patterns that could be avoided with automation and estimates gross revenue impact.
Govern what is automated
Clients choose which patterns and use cases should be enabled for Decisive Connect automation and which should be routed to personnel for review prior to delegating to automations.
Revenue Integrity Workflows
Connect, Reveal, Automate, Delegate, and Prevent Revenue Leakage
Decisive Connect helps revenue integrity teams move from retrospective cleanup to measurable, proactive workflows that protect reimbursement before leakage becomes denials, resubmissions, appeals, underpayments, or write-offs.
Connect Clinical and Financial Data
Unify EHR, RCM, claims, and remittance data so teams can measure leakage and identify denial opportunities.
Reveal Denial and Revenue Leakage Patterns
Identify recurring denial drivers, reimbursement leakage patterns, and high-value automation opportunities.
Automate Revenue Leakage Resolution
Resolve trusted charge and claim issues automatically before they become denied or unreimbursed receivables.
Delegate Exceptions for Review
Route exceptions to the right people with context, recommendations, and automation-ready task actions.
Prevent Denials Upstream
Embed rule-based and predictive decision support into upstream workflows to prevent denials and leakage where they begin.
Capability 01
Connect Clinical and Financial Data
Connect clinical, administrative, claims, and remittance data into a unified view that measures leakage opportunities, identifies where revenue integrity workflows need attention, and tracks progress as automations and operational changes improve outcomes.
- Measure missed charge capture, denial trends, underpayments, and write-off risk.
- Proactively identify denial risk and potential revenue leakage across connected data.
- Prioritize improvement opportunities by workflow, owner, and revenue impact.
- Monitor ongoing performance after automations and process changes go live.
Revenue Leakage Dashboard
Total Denial Amount
$57,596,548
Technical Denial Amount
$40,402,486
Denial Amount by Financial Class
Commercial
Medicare
Medicaid
Top 10 Avoidable Denials by Amount
Top 10 Avoidable Denials by Count
Write off Amount by Month
Denial Amount by Month
posted date: November 2024
Sum of denial amount: $1,319,827
Revenue Integrity Dashboard Overview
See financial exposure, avoidable denial opportunities, and performance trends in one connected analytics view.
Pattern Discovery
Denial and Leakage Signals
Capability 02
Reveal Denial and Revenue Leakage Patterns
Claims, remittance, charge, and workflow history can be analyzed to reveal where denials and reimbursement leakage are concentrated, which operational patterns keep repeating, and which issues are strong candidates for automation or guided review.
- Group recurring denial drivers by payer, workflow, functional area, and operational owner.
- Quantify revenue exposure so teams can prioritize the highest-value patterns first.
- Convert pattern findings into automation candidates, review queues, and upstream interventions.
Capability 03
Automate Revenue Leakage Resolution
Trusted patterns can be resolved through Decisive Connect automations that update charges, correct claim context, add missing reimbursement-supporting information, or prepare downstream actions before denials and write-offs occur.
- Automate recurring charge and claim corrections without manual touch.
- Run rules nightly, on demand, or as part of event-driven revenue integrity workflows.
- Example: identify documented blood pressure activity and create the approved Category II charge automatically.
Category II Blood Pressure Revenue Capture
match_cat_II_pattern
1
2
3
4
5
6
7
8
9
10
select
fin, service_dt_tm,
systolic, diastolic,
cdm_code, diagnosis_codes,
provider_context
from clinical_bp_activity
where missing_category_ii_bp_charge = true
and patient_age_years >= 18
and location_type not in ('LAB', 'RADIOLOGY')
and diagnosis_and_provider_context = 'resolved'
Workflows
0 of 164 row(s) selected
Capability 04
Delegate Exceptions for Review
Not every pattern should be resolved autonomously. Decisive Connect can route exceptions to the right person with the supporting context, recommended resolution path, and automation-ready task actions that make review faster and more consistent.
- Route unresolved work to the right team member, operational owner, or review queue.
- Give reviewers the context needed to approve, reject, or delegate the resolution.
- Delegate resolution steps from manual work queues to highly efficient automated task actions.
- Example: transfer lab charges outside encounter service dates to the related encounter.
Capability 05
Prevent Denials Upstream with Embedded Decision Support
Decisive Connect can place clinical and financial decision support into clinical care, scheduling, admission, utilization review, prior authorization, and billing-readiness workflows so users are notified while there is still time to prevent the denial or leakage event. Those interventions can be driven by rules and predictive signals learned from historical claims and remittance outcomes.
Select any workflow example to see how the intervention works.
Scheduling and Credentialing
Catch provider credentialing issues at appointment creation and before the visit occurs.
Scheduling Workflow 1 of 2
Utilization Management
Surface admission-status and short-stay risks while the patient is still in care.
Utilization Management Workflow 1 of 2
Prior Authorization
Identify authorization, documentation, payer, and site-of-service requirements before service.
Prior Authorization Workflow 1 of 2
Representative Client Impact
Revenue Integrity Automation With Measurable Enterprise Impact
In a representative enterprise healthcare deployment, Decisive Connect helped identify revenue leakage, automate trusted charge and claim resolution patterns, reduce avoidable errors, and recover receivables that may otherwise have remained delayed, denied, or written off.
Results reflect a representative client deployment and are provided as an example of measurable impact. Actual outcomes vary based on provider size, payer mix, data quality, workflow scope, and approved automation use cases.
Client Results
- Large multi-site healthcare provider environment
- Revenue integrity and charge reconciliation workflows
- Analytics, pattern detection, and automation supporting proactive error resolution
- Integration across clinical, financial, claims, remittance, and third-party data sources
- ROI measured through client-specific operational and financial reporting
Representative ROI Dashboard
Multi-Year Operating Period
Engagement
Multi-year
Client Scope
Enterprise deployment
Revenue at Risk Addressed
$180M+
Gross revenue tied to charge reconciliation, denial-risk, and revenue leakage workflows addressed through automation.
Reduced AR exposure and reimbursement leakage
Revenue Recovered
$3.5M+
Receivables recovered through automated identification and resolution of charge and claim issues.
Receivables protected and recovered
Automated Actions
2.6M+
Automation actions executed across the engagement period
Error and Denial Reduction
80%+
Reduction in targeted charge errors and avoidable denial drivers
Representative workflow impact
Estimated Labor Savings
$800K+
Estimated operational savings from automated resolution
The Decisive Connect Platform
Intelligent Workflow Automation at the Speed of Care
Decisive Connect evaluates clinical, administrative, and financial data in real time, then triggers the workflows, automations, and notifications needed to correct reimbursement risk at the source. The platform can use native CDS Hooks where available, and can deliver CDS-like intelligence through event-driven integrations where native hook support is limited or unavailable.
Platform Capabilities
Decisive Connect is a multi-capability healthcare platform, not a single-purpose solution. Its data, integration, intelligence, workflow, notification, and automation capabilities can support a wide range of clinical, administrative, and financial operating patterns.
Healthcare Data Platform
Create a governed data foundation for revenue integrity, archival, analytics, and downstream operational use.
- EHR/RCM data migrations
- Clinical and financial data archive
- Data integration to third-party solutions
- Data-driven AI/ML model training and algorithm development
- Claims, remittance, charge, and workflow data normalization
- Revenue leakage analytics and longitudinal trend reporting
Healthcare Integration Platform
Connect the systems, standards, and event patterns that support clinical, administrative, and financial workflows.
- HL7 v2 and FHIR API integration
- X12 EDI integration for claims and remittance workflows
- CDS Hooks Server, clinical decision support, and financial decision support
- RCM/EHR custom integrations with third-party platforms
- SFTP, API, event-driven, and database connectivity patterns
Workflow and Notifications Platform
Route insights into the right operational workflow with notifications, collaboration, and task-based action paths.
- Embedded clinical and financial workflow notifications
- Healthcare and enterprise collaboration integrations including TigerConnect, Microsoft Teams, Google Chat, Slack, and many more
- SMS notifications
- Email notifications
- Custom end-user workflows, work queues, and approval paths
Standards-Aware, Workflow-Agnostic
Decisive Connect is EHR/RCM platform agnostic and built to integrate with the systems that already run clinical, administrative, and financial workflows. The platform can support API integration, HL7 FHIR, HL7 v2, and EDI X12 patterns, while using native CDS Hooks or CDS Hooks-equivalent notifications where workflow intervention is needed.
CDS Hooks and Custom Event Triggers
The Decisive Connect CDS Hooks server can support standard CDS Hooks events where available, and can also handle custom clinical, administrative, and financial events when a workflow needs intervention outside the standard hook set.
Implementation and Time to Value
A Practical Path From ROI Assessment to Live Workflows
Decisive Connect is designed to show value before a client commits to a broader subscription or license. The Revenue Leakage Assessment uses Rapid Connect to quickly evaluate historical claims and remittance data, identify denial patterns, and quantify automation opportunities. From there, clients can launch the highest-impact use cases first, then evolve into the Direct Connect model over time for richer analytics, deeper source-system integration, and broader workflow automation.
Quickly Identify Issues with an ROI Assessment
Use Rapid Connect to ingest historical claims and remittance data, quantify denial exposure, and identify quick-ROI automation opportunities tied to the largest reimbursement leakage patterns.
Prioritize Quick-Hit ROI
Map AI based insights and pattern matching to the Decisive Connect automations most likely to avoid denials before claim submission.
Govern the Automation Path
Define which patterns can be automated, which require personnel review, and how alerts, routing, exception handling, and ownership should work.
Validate Alerts and Automations
Test recommendations and automations against real workflow scenarios before production launch, using client-approved rules and operational boundaries.
Evolve to Direct Connect
After value is proven, expand into the Direct Connect model for deeper source-system integration, more robust analytics, and broader workflow intelligence over time.
Start With ROI. Expand With Direct Connect.
The goal is quick proof of measurable value, not a long transformation program. Rapid Connect supports the initial assessment and quick-hit automation path, while Direct Connect creates the foundation for more robust analytics and deeper operational integration as the relationship matures.
Leadership Team
With a leadership team that collectively has 100+ years of healthcare IT industry experience, you can confidently count on us to help drive the best possible outcomes for your organization.
Bob Hansen
Co-Founder and CTO
Bob brings more than 30 years of healthcare IT experience spanning product development, product management, clinical workflows, revenue cycle, and complex system integration. He focuses on building practical technology that helps healthcare organizations connect data, streamline operations, and deliver measurable financial and clinical workflow outcomes.
Ron Murphy
Co-Founder and COO
Ron brings more than 30 years of experience in healthcare revenue cycle management and consulting. He has helped health systems solve complex challenges, improve workflows, and implement practical solutions. At Decisive Connect, Ron guides strategy and operations while supporting the platform's growth and client success.
Marty Schoenthaler
Vice President Product Development
Marty is a veteran of healthcare IT with over 20 years of experience using industry-leading EMR systems to help clients achieve their clinical and financial goals. He specializes in software development and the application of new technologies to keep pace with the ever-changing needs of healthcare organizations.
Joe Cowan
Vice President of Client Success
Joe brings two decades of healthcare IT experience developing practical solutions across complex healthcare systems and workflows. He brings together technical, clinical, financial, and operational stakeholders to solve complex problems, simplify healthcare operations, and improve the experience for providers and administrative staff.
Ethan Hansen, PhD
Principal Research Scientist
Ethan holds a PhD in Quantum Physics with a focus on quantum computing. His expertise in complex systems, advanced computation, applied AI, and automation brings a research-driven perspective to Decisive Connect, helping translate advanced methods into practical, intelligent workflows for healthcare revenue operations.
Frequently Asked Questions
Answers to common questions about Decisive Connect, implementation, integrations, security, and pricing. If you need more detail, contact us.
Contact Us, Book a Demo, or Request an ROI Assessment
Contact a Member of Our Leadership Team Directly
Reach out to the person closest to your question to learn more, discuss your revenue integrity priorities, book a personalized demo, or request a Revenue Leakage / ROI Assessment powered by Rapid Connect. You can also use the general inbox and we will route your message to the right person.
Bob Hansen
Co-Founder and CTO
Ron Murphy
Co-Founder and COO
Marty Schoenthaler
Vice President Product Development
Joe Cowan
Vice President of Client Success
Ethan Hansen, PhD
Principal Research Scientist
Follow us, or reach us through our general inbox.