Pilot Measurement Model
Connects each RequiSure recommendation to the eventual human, testing, claim, and financial outcome — so pilot value can be measured on real data, not asserted.
No predictive denial model or autonomous rule learning at this stage. All current values are synthetic.
Recommendation → Outcome Chain
RequiSure RecommendationRequiSureIMPLEMENTED
Human ActionOperational staffSIMULATED
Testing ActionLaboratory (CrelioHealth)FUTURE INTEGRATION
Claim OutcomeRCM (PayMedics)FUTURE INTEGRATION
Financial OutcomePayer (Novitas / BCBS)FUTURE INTEGRATION
Shadow-Mode Observations
Synthetic — Requires Real Pilot Data
Observations recorded0
Agreement0
Disagreement0
Agreement rateRequires Real Pilot Data
Pilot Metrics (defined · awaiting real data)
Agreement rateRequires real pilot data
False holdsRequires real pilot data
Missed issuesRequires real pilot data
Preventable-denial rateRequires real pilot data
Documentation remediation rateRequires real pilot data
Time to resolutionRequires real pilot data
Clean claim rateRequires real pilot data
Denied dollarsRequires real pilot data
Recovered dollarsRequires real pilot data
Estimated avoided testing costRequires real pilot data
Denial Taxonomy Context
How measured pilot outcomes will map to the first-pilot denial groups. The authoritative, detailed taxonomy lives on the dedicated Pilot Denial Taxonomy page.
Group A
Pre-Service / Potentially Preventable by RequiSure
Primary first-pilot opportunity — identifiable before the lab performs the test.
Group B
Downstream / Future RCM Scope
Not first-pilot scope. May later become analytics inputs, RCM feedback, or future capabilities.
Group C
Requires Case-Specific Review
May be upstream or downstream depending on the facts.
≈ 50%Collaborator hypothesis that approximately 50% of current denials may involve issues potentially identifiable before or around the time of testing. This has not been validated.Collaborator Estimate — Requires Validation
No predictive denial model or autonomous rule learning at this stage. All values are synthetic and for validation planning only.