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Illustrative Scenarios

Case Studies:
From Denial to Cash

Illustrative, modelled pre-revenue scenarios showing how previously written-off revenue could convert into recoverable cash flow — without requiring a single change to clinical workflows.

⚠️

Illustrative & modelled. Ardia is pre-revenue (founded December 2025, Dallas–Fort Worth) and has not yet deployed with any organization named on this page. Every scenario, denial-rate change, appeal outcome and dollar figure below is a modelled target grounded in public denial patterns and payer policy — not a measured client result or testimonial.

Precision Medicine

Genomic & Molecular Diagnostic Case Studies

How MolecuIQ™ is built to turn CO-55 "Experimental" denials and NGS panel rejections into recoverable revenue — with peer-reviewed evidence as the weapon.

Case Study · MolecuIQ™ · CO-55 Defense

NSCLC NGS Panel: Defeating 47 CO-55 "Experimental" Denials

Molecular oncology lab · DFW · EGFR/ALK/ROS1/KRAS panel · Palmetto GBA MolDX

Illustrative
Synthetic scenario · pre-revenue
27%
Pre-Ardia denial rate
6%
Post-Ardia denial rate
72%
Modelled win rate
38 days
Days to first recovery

The Problem

A DFW oncology molecular lab running EGFR/ALK/ROS1/KRAS NGS panels for NSCLC patients faced a 27% denial rate — primarily CO-55 "Experimental/Investigational" denials from Medicare Advantage Humana HMO. Without MolDX Z-code validation pre-submission, panels were denied at the claim level before clinical review.

The Ardia Solution

MolecuIQ™ applies NCCN guideline RAG retrieval — automatically generating Letters of Medical Necessity citing Category 1 NCCN recommendations for NSCLC molecular profiling (NCCN NSCLC v2.2025, pages MS-5 through MS-12). In this modelled scenario, Z-code pre-submission validation is projected to prevent the majority of initial denials. Remaining CO-55 denials would be appealed with auto-generated evidence packages grounded in policy and the patient record.

Appeal Narrative Sample

"Per NCCN NSCLC Guidelines v2.2025 (Category 1), comprehensive molecular profiling including EGFR, ALK, ROS1, and KRAS is recommended for all patients with stage IIB-IV NSCLC prior to first-line treatment selection. The disputed CPT 81479 panel directly corresponds to this Category 1 recommendation. CO-55 designation as 'Experimental' is inconsistent with NCCN evidence grade and contradicted by FDA-approved targeted therapy biomarkers (EGFR: osimertinib; ALK: alectinib; ROS1: crizotinib). Appeal is requested for claim reversal."
✓ Modelled target: ~72% of CO-55 appeals reversed with this approach
Case Study · MolecuIQ™ · PGx Reimbursement

CYP2D6 Pharmacogenomics: Recovering Denied PGx Revenue

Specialty PGx lab · Irving, TX · CPT 81226/81240 panels · BlueCross TX & UHC

Illustrative
Modelled scenario · pre-revenue

The Problem

A specialty PGx lab in Irving, TX running CYP2D6/CYP2C19 panels for antidepressant prescribing optimization faced systematic CO-50 "Not Medically Necessary" denials from BlueCross TX and UHC. Root cause: physician notes lacked documentation of failed antidepressant trials — the specific LCD criterion for PGx testing medical necessity.

In this modelled scenario, roughly a third of CPT 81226 claims are denied. Manual appeal cost of $118/claim (industry benchmark) makes most economically irrational to appeal — a modelled six-figure annual write-off.

The Ardia Solution

MolecuIQ™ implemented a pre-submission documentation intelligence check — scanning EHR clinical notes for documented prior medication failures before claim submission. When gaps were found, the system generated a physician-facing documentation prompt (not a clinical alert, but a billing requirement notice).

34%→8%
Denial rate
68%
Modelled win rate
15%
Contingency
Case Study · MolecuIQ™ · Precision Medicine

Genomic Risk Stratification: Modelled Shared Savings via Biomarker Intelligence

North Texas ACO · 5,500+ providers · Hereditary cancer panel + cardiovascular genomics

Illustrative
Modelled scenario · pre-revenue

The Opportunity

A North Texas ACO managing 100,000+ Medicare beneficiaries had genomic test results sitting in lab records — never connected to population health risk stratification. BRCA1/2 results, hereditary cancer panels, and cardiovascular pharmacogenomics data (SLCO1B1 for statin myopathy risk) were in the system but not translated into HCC coding opportunities or high-risk patient identification.

The Ardia Solution

MolecuIQ™ connects genomic lab results to population health workflows — surfacing patients with actionable hereditary risk markers that had not been coded into their HCC risk profiles. In this modelled scenario, proactive care coordination for high-risk patients is projected to reduce downstream ER admissions and generate additional MSSP shared savings.

Key insight: Genomic data is the most underutilized population health signal in ACO management. MolecuIQ™ transforms lab results from billing documents into shared savings opportunities.
ToxIQ • Toxicology Lab

The Toxicology Turnaround: DFW Mid-Size Lab

A Dallas-Fort Worth toxicology lab facing 41% denial rate on definitive testing (G0480–G0483) from Medicare Advantage plans citing CO-50 medical necessity, writing off $500,000+ annually.

41%→10%
Denial Rate
$500K
Modelled Recovery
90 days
Time to Results

Challenge: Medicare Advantage payers systematically denying definitive drug confirmatory tests. Lab's billing team spent 3–4 hours per denial manually pulling records — a process costing more than the claim value for tests under $150.

Solution: ToxIQ is built to ingest the EDI 835 denial stream and identify that the primary driver is a missing "inconsistent finding" notation. The platform is designed to detect prescription/UDS inconsistencies and draft appeal letters — for licensed review — citing Medicare LCD L35006 §3.1 in about 1.4 seconds per claim.

Illustrative outcome: for a lab with this denial profile, ToxIQ's documentation-pattern detection is modelled to recover more than the annual cost of a billing team within the first quarter.
EMS • Ambulance Revenue Defense

EMS Revenue Rescue: Municipal Ambulance Service

A municipal ambulance service experiencing high denial rates from Medicare on non-emergency transport claims — insufficient documentation of the strict "bed confinement" requirement paramedics rarely state explicitly.

$400K
Modelled Recovery
Zero
Workflow Changes
98%
Modelled Confidence

Challenge: Paramedics prioritize patient care over paperwork, often failing to use the exact phrasing "bed-confined" required by Medicare. Thousands of legitimate claims denied annually because clinical language differed from bureaucratic language.

Solution: Ardia's Narrative Reconstruction module is built to scan Patient Care Reports for clinical proxies — terms like "lifted via drawsheet," "severe contractures," "unable to ambulate" — and logically infer these meet the strict Medicare bed-confinement definition, drafting valid legal arguments for payment that a licensed professional reviews.

MolecuIQ • PCR Molecular Lab

CO-55 Destruction: PCR Lab Experimental Denial Defense

An independent PCR molecular lab processing UTI and respiratory panels experiencing 27% denial rates on CO-55 "Experimental or Investigational" codes from commercial payers lagging guideline adoption.

27%→6%
CO-55 Denial Drop
72%
Modelled Win Rate
Illustrative
At Stake (illustrative)

Solution: MolecuIQ uses a RAG system retrieving IDSA, AUA, and PubMed literature to construct Letters of Medical Necessity. Each appeal cites 3–5 peer-reviewed studies proving the test is standard of care, formatted to the specific payer's requirements.

Illustrative outcome: a workflow that once took ~45 minutes of manual drafting per CO-55 appeal is modelled to produce a complete, literature-backed letter in about 90 seconds.
ToxIQ • OTP / MAT Network

MAT Revenue Defense: Opioid Treatment Program Network

A multi-location OTP network experiencing systematic denials on urine drug screen (UDS) claims from Medicaid managed care payers — insufficient documentation linking UDS results to the MAT plan.

$1.5M
Modelled Recovery
76%
Modelled Win Rate
28%→8%
Denial Reduction

ToxIQ is built to correlate UDS results with clinical notes, drafting appeal letters — for licensed review — that trace the clinical decision pathway from UDS result to dosing adjustment. The system estimates that a majority of denials could be defeated by adding a single documented clinical rationale sentence linking the drug screen result to the Suboxone/methadone dosing decision.

DFW Priority Targets

Top 5 DFW Prospects

Illustrative go-to-market targets. Organizational details are drawn from public sources; the “Est. Denial Volume” figures are Ardia estimates modelled from public denial patterns and payer policy — not confirmed engagements, audited financials, or client results.

OrganizationLocationModuleRationaleEst. Denial Volume
A prospective design-partner labDenton, TXMolecuIQA high-volume PCR molecular lab in the DFW area — a strong early design-partner fit for MolecuIQ across genomic & PGx reimbursement workflows.$8M+/yr
A fast-growing tox + molecular labIrving, TXToxIQ1M+ tests/year. Active acquirer. ToxIQ standardizes interpretation across acquired labs without retraining staff.$12M+/yr
A prospective design-partner labDallas, TXToxIQA DFW toxicology lab actively pursuing AI integration — a high-intent early adopter for ToxIQ.$3M+/yr
A large North-Texas value-based-care networkFarmers Branch, TXMolecuIQ100,000+ Medicare lives across North Texas. MolecuIQ surfaces uncoded genomic & PGx risk markers — precision-medicine reimbursement at scale.$23M+/yr
A large US opioid-treatment-program networkDallas, TX (HQ)ToxIQA large OTP network — tens of thousands of patients across 100+ locations. High-volume UDS / toxicology denial defense.$15M+/yr