Reducing avoidable denials is one of the greatest opportunities to protect and strengthen hospital net revenue. Each avoidable denial represents care that has already been delivered and reimbursement that, with the right processes in place, can still be secured. Utilization review (UR) leaders who focus on comprehensive documentation, timely reviews, and collaborative payer relationships are best positioned to turn these opportunities into sustainable financial outcomes.
Citizens Medical Center found that path through Xsolis GenAI Initial Review, a generative AI tool that produces editable clinical summaries. After integrating it into its utilization review workflow, the hospital reduced its denial rate by 12%, cut payer response times in half, and gave its utilization review nurse room to apply clinical judgment where it matters most.
This post examines how a more than seven-year partnership evolved into a generative AI deployment, what changed across two software versions, and the measurable outcomes that followed.
The Citizens Medical Center and Xsolis relationship spans more than seven years, built on a foundation of trust and a shared commitment to smarter utilization management. Since 2018, Citizens Medical Center has expanded its use of Xsolis’ AI-driven solutions, including Dragonfly Utilize, Physician Advisor Services, Denial Management Services, and Precision UM with a large national payer.
The most recent enhancement includes the addition of GenAI Initial Review. For Renee Dunagan, Director of Case Management at Citizens Medical Center, it was a natural next step.
GenAI Initial Review extended that partnership into the new territory of generative AI for Citizens Medical Center. The offering generates concise, comprehensive, and editable AI-guided clinical summaries, giving UR nurses a strong starting point.
Renee was enthusiastic about the technology, but she approached implementation deliberately. Knowing that leadership and frontline buy-in would be essential, she brought in Citizens Medical Center’s Chief Financial Officer, Duane Woods, early to secure organizational support and engaged her frontline team from the outset. With that groundwork in place, the pilot launched in May 2025.
The results were immediate. Version one delivered measurable workflow efficiencies, delivering approximately five minutes of time savings per review. The time saved allowed Renee’s UR nurse to redirect her time toward higher-complexity patients.
According to Renee:
“With GenAI Initial Review, our UM nurse moves through her caseload more quickly and can focus on the gray zone cases that need her attention. It has completely changed her outlook on her role, allowing her to apply her critical thinking skills where they matter most.”
The AI-generated summaries also served a broader purpose, giving all providers on a case a clear clinical synopsis without requiring them to read through every consult note.
Version two of GenAI Initial Review was, in Renee’s words, a significant improvement. Launched in October 2025, the updated offering introduced a condition-based model that meaningfully improved the accuracy of AI-generated clinical summaries.
The upgrade didn’t happen in a vacuum. Renee and her team actively contributed feedback following the version one pilot, alongside insights from other Xsolis clients, and that input directly shaped version two. The new version improved the clinical depth of summaries, particularly for complex cases where capturing a complete picture of the patient’s condition is critical to meeting payer expectations.
The impact on Renee’s team speaks for itself. As she noted:
“With GenAI Initial Review, my UR nurse trusts that the clinical summaries provide payers what they need to make status determinations.”
The gains extended beyond efficiency, more comprehensive clinical summaries, and increased staff satisfaction. Renee was particularly impressed with how payers responded. By delivering the right clinical information upfront, Citizens Medical Center has reduced unnecessary back-and-forth and enabled more productive conversations with payers. In Renee’s words:
“GenAI Initial Review has improved our payer interactions. We’re able to have more in-depth conversations because we’re providing the clinical information they need upfront. Payer response times have also improved significantly, dropping from 24 hours to 12 hours, as payers spend less time digging through charts to find relevant data.”
The most consequential result is a 12% decrease in denial rate, a win for Citizens Medical Center’s bottom line and, more importantly, for its patients.
The Citizens Medical Center experience offers a clear model for health systems weighing generative AI in utilization management.
For UR leaders, the takeaway is concrete. AI-driven clinical summaries can reduce review time, strengthen payer collaboration, and lower denial rates when implemented with clear ownership and measurable goals.
Citizens Medical Center reduced its denial rate by 12% after adopting GenAI Initial Review. The hospital also cut payer response times from 24 hours to 12 hours.
No. GenAI Initial Review supports Citizen Medical Center's nurses rather than replacing them. The tool generates a starting summary, and the UR nurse verifies, refines, and finalizes it. This frees nurses to focus on complex gray zone cases that require clinical judgment.
Results were immediate. The version one pilot launched in May 2025 and delivered approximately five minutes of time savings per review from the start. Version two, launched in October 2025, added deeper clinical accuracy.