AI workers help health systems and RCM companies prevent denials and recover revenue, showing the evidence behind every recommendation.
PALO ALTO, Calif., Sept. 11, 2026 /PRNewswire/ — Penguin Ai, the company building an AI workforce for healthcare administration, today announced the launch of Intelligent RCM, an AI workforce built for revenue cycle teams to reduce denials, recover underpayments, and shorten the time from care delivered to payment received.
Intelligent RCM extends Penguin Ai’s work in healthcare administration into the revenue cycle, applying the same healthcare-native, governed AI to the claims workflows that determine whether organizations get paid for care they have already delivered.
The AI workers carry the work of building the case: pulling the evidence, checking the claim, drafting the appeal. Specialists keep the judgment and get their hours back.
Why Revenue Cycle Needs a Different Approach
Denials, underpayments, and rework cost payer and provider teams money and time. The tools built to fix them have mostly added queues. Specialists spend their days reassembling evidence they already understand and chasing deadlines across systems that don’t talk to each other.
“Behind every denial is a patient waiting while two organizations argue about a form, and a specialist spending her afternoon hunting for evidence she already knew existed,” said Fawad Butt, CEO of Penguin Ai. “We built Intelligent RCM to stop the preventable denials before the claim goes out and to put the evidence behind every action it recommends. The specialist still makes the decision. She just stops spending her day building the case for her own judgment.”
One Platform Across Prevention, Recovery, and Payment Integrity
Intelligent RCM connects three functions that revenue cycle teams have bought and run as separate tools.
Pre-Submission Review examines every claim before the 837 transmits, checking eligibility, authorization, coding, medical necessity, and payer-specific policy. Each finding comes with the evidence behind it, a recommended fix, and the dollars at risk. A specialist can resolve, dismiss, reassign, or escalate, and cleared claims collect in a queue ready for export.
Denials, Appeals and Recovery starts when remittance data comes in. The AI worker classifies every denial by root cause and routes it to the path that fits it, whether that is a corrected claim, an appeal, a peer-to-peer, or documented closure. It ranks the work by recoverable value, days to deadline, win probability, and audit risk, so the highest-value cases surface first. Whatever the path, a working draft is ready on first open. Payer status and 835 reconciliation follow each case through to payment, so teams know whether the appeal or correction worked.
Payment Integrity identifies underpayment and variance against contract and fee-schedule terms, showing the calculation behind each finding and closing the loop to a reconciled outcome.
What Makes Intelligent RCM Different
Intelligent RCM is explainable and human-controlled at every step. Each recommendation carries the evidence behind it, and an immutable audit trail records what a specialist does. The queues show financial value, denial risk, deadline, and win probability, along with the reasoning behind the ranking, so teams work the highest-value cases first.
The platform is glassbox. Every finding shows its evidence and the reference data behind it, and where the data falls short, it says so. Nothing hides behind a score a specialist cannot inspect.
People stay in control. The AI worker produces a strong first draft, and the specialist owns the review and the final approval. Submission stays with the customer, who controls when the work goes out. Prevention, recovery, and payment integrity run in one connected workflow, built for regulated operations with multi-tenant architecture and tenant isolation.
Revenue cycle leaders can see Intelligent RCM in person at Becker’s Health IT + Revenue Cycle, September 14 to 17 at the Hilton Chicago, where Penguin Ai is exhibiting at Booth 5414.
About Penguin Ai
Penguin Ai builds an AI workforce for healthcare administration. Its AI workers take on prior authorization, medical coding and risk adjustment, claims, appeals, payment integrity, and revenue cycle work for health plans, providers, and risk-bearing organizations, with a human in the loop at every step and glassbox reasoning behind every recommendation. Penguin Ai runs on Snowflake, AWS, and Databricks. Founded by the former Chief Data Officer of Kaiser Permanente, UnitedHealthcare, and Optum, Penguin Ai is working to remove the $1 trillion a year that administrative inefficiency costs healthcare. Learn more at www.penguinai.co.
Media Contact for Penguin Ai: penguinaiPR@supremecomms.ai
SOURCE Penguin Ai