From Reactive Revenue Recovery to Proactive, AI-Enabled, Outcome-Driven RCM

Rising payor denials, prior authorization friction, higher operating costs, and expected Medicaid coverage losses are pushing healthcare providers to protect revenue, not just cut costs. They are fixing intake and authorization before claims are submitted and prioritizing revenue integrity and underpayment recovery. AI is moving into production RCM workflows and handling high-volume tasks while staff focus on complex exceptions. With workforce strain growing, healthcare providers are moving toward outsourcing partnerships tied to measurable results. Service providers are shifting from labor-led to platform-led delivery. They are investing mainly in AI R&D and building AI agents across the revenue cycle, from patient access to denial prevention and accounts receivable follow-up.

Both demand-side and supply-side trends are covered in our Revenue Cycle Management (RCM) Business Process Transformation 2026 Market Insights™ and Revenue Cycle Management (RCM) Business Process Transformation 2026 RadarView™, respectively.

These reports present a comprehensive study of RCM service providers and closely examine market leaders, innovators, disruptors, challengers, and tech pioneers.

Avasant evaluated 51 service providers across two dimensions: practice maturity and future-proofing. Of the 51 providers, we recognized 31 that brought the most value to the market during the past 12 months.

The RadarView recognizes service providers in five categories:

• • Leaders: Access Healthcare, AGS Health, Cognizant, Firstsource, GeBBS Healthcare Solutions, Omega Healthcare, Optum, and R1 RCM
  • Innovators: Capgemini, Conifer Health, CorroHealth, Genpact, IKS Health, Infinx, NextGen Healthcare, and Sagility
  • Disruptors: Atos, Coronis Health, Guidehouse, HCLTech, PwC, Sutherland, Vee Healthtek, and XBP Global
  • Challengers: Savista RCM, Shearwater Health, and TP
  • Tech Pioneers: Athenahealth, FinThrive, EClinicalWorks, and Veradigm

Figure 1 below from the full report illustrates these categories:

“The real opportunity in RCM is not automating the average transaction; it is shrinking the exception economy,” said Avasant Senior Director Chirag Sharma. “As routine work becomes increasingly autonomous, competitive advantage will come from preventing exceptions and resolving the ones that remain with greater speed, intelligence, and accountability.”

The reports provide several findings, including the following:

• • About 84% of medical groups reported higher operating costs in 2026, up about 11% on average. Rising costs and expected Medicaid coverage losses are pushing healthcare providers to protect revenue, not just cut costs.
  • Healthcare providers are preventing denials upstream by fixing eligibility, registration, and authorization gaps before claims are submitted. They are also prioritizing revenue integrity, underpayment recovery, and patient financial engagement.
  • About 88% of health systems use AI, and 71% have deployed it in finance, revenue cycle, or clinical areas. Healthcare providers are applying AI to documentation, coding, eligibility, and denials to absorb high-volume work and redeploy staff to higher-value tasks, rather than eliminate roles.
  • Service providers are shifting from labor-led to platform-led delivery, embedding AI and autonomous agents across eligibility, prior authorization, coding, CDI, denial prevention, and AR follow-up.

“Healthcare providers are using AI to absorb high-volume work across documentation, coding, eligibility, and denials, shifting staff to higher-value tasks instead of cutting roles,” said Ashutosh Darmal, principal analyst at Avasant. “To ease strain, they are moving to outcome-based partnerships pairing AI automation with new staff tools.”

The RadarView also features detailed profiles of 31 service providers, along with their solutions, offerings, and experience in assisting enterprises in their RCM services journeys.

This Research Byte is a brief overview of Avasant’s Revenue Cycle Management (RCM) Business Process Transformation 2026 Market Insights™ and Revenue Cycle Management (RCM) Business Process Transformation 2026 RadarView™. (Click for pricing.)