Prevent
Radiology Denials
AI revenue cycle automation built for radiology groups — specialty-aware coding, prior auth for advanced imaging, and denial appeals that protect payment across every study.
55%+
denials prevented
98%
coding accuracy
3 days
to onboard
Trusted by Industry Leaders
Why radiology claims get denied
Radiology runs on high volume, split billing, and payer-controlled imaging utilization — a combination that turns small coding gaps into large, repeatable revenue leakage. Most losses trace back to a handful of recurring issues.
Professional/technical splits go wrong
Modifier 26 and TC billing has to match the site of service, equipment ownership, and rendering provider exactly. A misapplied split — or a global bill where only the professional component is owed — denies or triggers takebacks on otherwise clean studies.
Advanced imaging stalls on prior auth
CT, MRI, PET, and nuclear studies sit behind payer and radiology-benefit-manager pre-auth rules. Missing or mismatched authorization on a high-cost study is one of the most common — and most expensive — radiology denials.
Multiple-procedure reductions erode payment
MPPR rules cut the technical and professional components on subsequent imaging in the same session. Without correct sequencing and modifier logic, claims either underpay silently or deny for inconsistent reductions.
Contrast & supervision coding gaps
With vs. without contrast, supervision-and-interpretation codes, and radiopharmaceutical units all have to line up with the documentation. Small mismatches on these details fail payer edits and medical-necessity criteria.
High-volume, low-dollar leakage adds up
Radiology's claim volume means even a low single-digit denial rate represents real money. Manual review can't keep pace, so undercoding and missed charges quietly compound across thousands of studies.
Slow, reactive appeals
When denials hit, staff rebuild context by hand for every study — pulling orders, reports, and authorization records — while timely-filing deadlines close in on claims that are individually small but collectively significant.
Works with EHR & PMS
What Ember automates for radiology
Every study coded like a radiology coder would
Ember reviews each study the way your coders do — validating professional/technical (26/TC) splits, contrast and supervision codes, radiopharmaceutical units, and CPT/ICD pairing against the report before the claim goes out.
Prior authorization, handled
Ember checks eligibility, flags which CT, MRI, PET, and nuclear studies need pre-auth, gathers the order and clinical documentation from the EHR, and submits through payer and RBM portals — so high-cost imaging doesn't stall or deny.
MPPR-aware multiple-procedure logic
Ember sequences same-session studies and applies multiple-procedure reduction rules correctly across technical and professional components — so you're paid accurately instead of silently underpaid or denied for inconsistent reductions.
Benchmarking to negotiate from
Ember tracks how your highest-volume and highest-value studies are coded, paid, and denied across payers — giving you the benchmark data to anchor rate negotiations and push back on underpayments.
Medical-necessity appeals on autopilot
When a denial cites medical necessity or authorization, Ember pulls the order, report, and auth record, cross-references payer policy, and drafts audit-ready appeal letters for review — so small-dollar studies don't get written off.
Accurate charge capture at volume
Automated charge-capture recommendations keep coding complete and compliant across high study volume — so contrast, add-on, and supervision charges aren't missed and revenue doesn't leak one study at a time.
Outcomes radiology teams can measure
55%+
of denials prevented before submission
98%
autonomous coding accuracy
50–75%
fewer staff hours on denial workflows
3 days
to onboard — value, not a year-long rollout
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
As Seen In
Frequently Asked Questions
Yes. Ember AI connects seamlessly with all major EHRs and PMS platforms — including Epic, Oracle Cerner, athenahealth, and eClinicalWorks — as well as payer portals. Our standards-based integrations automate prior authorization, eligibility verification, and claims submission, allowing you to preserve existing infrastructure while modernizing the revenue cycle.
Ember AI deployments are measured in weeks, not months. Most organizations complete pilot launch in under 30 days and scale enterprise-wide within a quarter. We provide a structured onboarding playbook, technical support, and change-management guidance so your teams achieve measurable ROI rapidly with minimal IT lift.
Yes. Ember AI is fully HIPAA and SOC 2 Type II compliant and signs Business Associate Agreements (BAAs) with all covered entities. Protected Health Information (PHI) is encrypted in transit and at rest, supported by role-based access controls, detailed audit logging, and continuous monitoring. Your organization retains complete ownership and control of its data.
Health systems, MSOs, and health plans using Ember AI typically achieve:
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
Yes. Ember's coding and scrubbing logic is specialty-aware for radiology — it understands professional/technical (26/TC) splits, contrast and supervision-and-interpretation codes, radiopharmaceutical units, and multiple-procedure reduction rules, and validates documentation against payer medical-necessity criteria before submission.
Yes. Ember checks eligibility, identifies which CT, MRI, PET, and nuclear studies require pre-authorization, gathers the order and clinical documentation from your EHR, and submits through payer and radiology-benefit-manager portals — reducing the authorization denials that hit high-cost imaging.
Yes. Ember validates the billing scenario for every study — global, modifier 26 (professional), or TC (technical) — against site of service and rendering provider, so you bill exactly what's owed and avoid the split-billing errors that cause denials and takebacks.
Radiology's volume means even a low denial rate is real revenue. Ember reviews every study automatically — catching undercoding, missed contrast and add-on charges, and MPPR errors at a scale manual review can't match — so revenue doesn't leak one study at a time.
Ember connects to your existing RIS/PACS, EHR/PMS, and payer systems with standards-based integrations — no rip-and-replace. Most teams pilot in days and see measurable ROI before scaling across modalities and sites.
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