Radiology Insurance Denial Reduction
A production-grade decision support system that reduces imaging denials by aligning clinical intent, exam selection, and payer policy — before the order is submitted.
Radiology denials are rarely about medical necessity. They are caused by misalignment between clinical reasoning, exam structure, and payer language.
Why Denials Happen
- Incorrect exam or study header selection
- Unstructured or payer-misaligned indications
- Missing staging, therapy, or prior imaging context
- Modality, tracer, or interval restrictions
Operational Impact
- Delayed patient care
- Repeated authorization cycles
- Manual staff rework
- Lost revenue and throughput
How OraDigit Solves This
Deterministic Clinical Rules
Encodes radiology logic, protocol constraints, and payer policy requirements into auditable, version-controlled rules.
- Correct exam selection
- Required documentation enforcement
- Payer-aligned logic
Explainable AI Assistance
Generates payer-ready justification text and explains recommendations in plain clinical language.
- No black-box automation
- Human-in-the-loop
- Clinical judgment preserved
Flagship Deployment: PET/CT
PET/CT was selected as the first deployment due to its high denial rates, strict policy definitions, and complex exam variants.
- Skull-to-Thigh vs Whole Body logic
- Oncology staging and response assessment
- Neuro and infection/inflammation use cases
CT, MRI, and Nuclear Medicine modules are planned extensions.
End-to-End Workflow
- Structured clinical inputs captured
- Exam and protocol recommendation generated
- Payer-ready justification created
- Readiness checks performed
- Export to EMR or authorization workflow
Expected Outcomes
- 50–70% denial reduction target
- Shorter time-to-scan
- Reduced staff rework
- Improved payer trust
Deployment Options
- Pilot (top denial categories)
- Enterprise rollout
- Continuous policy updates
Work With OraDigit
OraDigit partners with imaging centers and health systems to reduce denial risk while improving order quality.