Healthcare RCM teams are being asked to deliver more, in conditions that are becoming increasingly difficult to manage. Rising denials, fragmented payer workflows, tight staffing, growing regulatory expectations: all of these pressures continue to mount.

Industry statistics tell the story.

• In Experian’s State of Claims 2025 report, 54% of providers said claim denials continue to increase, with 41% reporting at least 1 in 10 claims is denied.
• According to Fierce Healthcare, most RCM teams report spending 51 to 75 hours per week on denial-related work tied to payer requirements, appeals, and rework.
• In a 2025 Guidehouse/HFMA survey, 69% of provider executives reported excessive information requests from payers, a common symptom of fragmented, non-aligned payer workflows that slow resolution and increase manual touchpoints.
• In Experian Health’s Short staffed for the long term 2023 survey, 96% of respondents agreed that staffing shortages are directly harming revenue recovery.

At the same time, clients expect faster onboarding, more predictable SLAs, and better interoperability without disruption to the systems they already use.

This is the environment behind the recent Artiva HCx 2026.1 release.

This update is designed to help healthcare RCM organizations improve execution in areas where pressure is now highest: eligibility, automation, financial accuracy, and communication.

Why Healthcare RCM Teams Are Feeling Squeezed

RCM teams are absorbing pressure from multiple fronts at once. Denials continue to demand attention, payer requirements shift, and staffing remains tight. But the real strain shows up in how work is executed day to day.

Execution spans different client PAS systems, payer portals, clearinghouses, and communication tools, each with its own rules and workflows. As a result, coordination happens manually. Processes vary from one environment to the next, and visibility is split across systems. Teams rely on individual effort and local workarounds to keep accounts moving.

The result is familiar: higher cost to collect, compounding rework, and execution that’s difficult to standardize, difficult to predict, and difficult to scale.

From Fragmentation to Control: HCx as the Operating Layer for Healthcare RCM

The core struggle in Healthcare RCM is not having a consistent operating layer governing how work gets done. Work moves forward, but without consistency, visibility, or systemic control.

An operating layer changes that dynamic. Rather than replacing systems of record, it sits above them, standardizing how work is prioritized, executed, and measured across environments. HCx fills that role for healthcare RCM by absorbing complexity at the platform level and enforcing one coherent way of working, with no disruption to existing client infrastructure.

One unified workspace for work and resolution

In a governed operating layer, work and resolution cannot live in separate systems. Execution only stays consistent when communication happens in context, within the same environment that prioritizes, guides, and tracks the work.

With the Artiva HCx 2026.1 release, that unified workspace now extends fully into digital communications. Powered by TCN’s communications infrastructure, voice, SMS, email, and IVR outreach are embedded directly inside HCx, so communication becomes part of the workflow instead of a disconnected step.

Agents manage both the work and the outreach required to resolve it from the same place, without external dialers or the need to switch systems. Context between work and communication is preserved.

Claim-aware, real-time guidance that governs execution

A unified workspace creates continuity, but consistency still breaks down at the moment work is performed when payer rules differ, deadlines shift, and risk evolves as an encounter moves through the cycle. Without real time guidance, execution depends on memory and local judgment.

HCx governs execution as work happens, adapting to the specific claim being worked, surfacing the right rules, priorities, and next actions in context. Decisions reflect structure, not recall.

This enables organizations to:

• Apply payer rules and deadlines consistently
• Align actions with urgency and recovery potential
• Reduce outcome variance by enforcing guardrails inside the workflow

By embedding guidance directly into execution, HCx standardizes outcomes without standardizing people, restoring control at scale.

Scaling yield without scaling overhead

When execution is governed at the system level, scale becomes structural instead of labor dependent. For RCM outsourcers operating across multiple clients, the operating layer changes how performance expands over time.

With HCx in place, outsourcers can:

• Scale throughput without adding proportional headcount, because execution is standardized by design
• Deliver more consistent performance across clients, even when underlying systems and payer rules differ
• Ramp new clients and new staff faster, by plugging work into an established operating model
• Maintain control and visibility at the portfolio level, not just account by account

These benefits don’t depend on individual workflows or release cycles, but emerge when work is unified, guided, and governed above client complexity. This allows outsourcers to grow with predictability instead of overhead.

Deepening the Operating Layer with 2026.1

The 2026.1 release strengthens HCx in the areas that matter most to governed execution. Each update deepens HCx’s role as the operating layer for healthcare RCM, extending control earlier in the workflow and across communication, automation, and financial oversight.

Earlier visibility into coverage, eligibility, and benefits

2026.1 brings insurance discovery as well as eligibility and benefit verification directly into HCx workflows, surfacing coverage risk earlier and in context. Teams can identify issues before they create avoidable rework or downstream denials, with actions and outcomes tracked at the encounter level. This shifts risk detection upstream, where it can be prevented rather than recovered.

Expanded, governed automation

Automation in 2026.1 runs through HCx workflows, not alongside them. Delivered Robotic Process Automation (RPA) use cases execute under the same governance that guides human work, ensuring repetitive steps scale without introducing blind spots or inconsistent outcomes. Automation becomes a controlled extension of execution, not a parallel system to manage.

Greater financial accuracy and control

Enhancements to fee handling, reversals, and configuration strengthen financial governance as volume and complexity grow. Transaction level visibility and audit stamping improve confidence in reconciliation and reporting, supporting consistent financial outcomes across clients and portfolios.

Explore a More Controlled Way to Operate

Fragmentation, variability, and rising expectations are now part of how RCM work gets done. The question isn’t whether your teams can push harder inside that complexity; it’s whether you have enough control to operate consistently across it.

When execution is governed instead of improvised, you spend less time chasing exceptions and more time delivering predictable outcomes. You can scale across clients without relying on heroics, reduce avoidable loss, and regain clarity over how work moves from effort to results.

The shift from absorbing complexity to operating above it is what makes sustained performance possible.

Ready to learn more about the latest HCx upgrade? Schedule a quick call to see how Artiva HCx 2026.1 can help reduce fragmentation, strengthen execution, and transform RCM performance across your operation.