AI Healthcare claim denials

How does AI Healthcare eliminate Claim Denials?

When you talk about advanced denial management technology, it states that 31% of healthcare professionals still use manual process for managing their denials. AI healthcare is arriving to make 100% healthcare organizations adopt touch less processes.

Artificial Intelligence in healthcare has already created significant impact by increasing the work flow and improving the productivity.

How AI and ML prevent denials?

  • Applying innovative technology enables healthcare professionals to increase the accuracy and potential of revenue cycle management.
  1. Predicting Potential Denials:

  • Machine learning allows the practices to identify any patterns are connected with the denials after applying the historical remittance data.
  • The future claims following the same pattern can be figured out and can be indicated to the team to reveal the potential issue when logged into history of the claim along with the rejections.
  • These indications alert the medical billing team to proceed with a caution.
  • However the control is not undertaken by AI completely, healthcare companies and professionals can decide to go forward and submit the claim but at the same time pause for a while to recheck the claims based on the machine learning technology.
  1. Enabling Proactive Adjustments:

  • When a problematic claim is identified, AI healthcare conducts analysis to figure out the root cause for the denials or the errored claim.
  • Medical billing team applies this information to edit smartly without any errors and submit the claim as AI fits in easily within the workflow.
  • It helps to elevate effective claim process by ensuring error free claims in the first place which is required when a claim is on the route to denials.
  1. Increasing clean claim submissions:

  • Error free claims on the front end are equal to fewer denials on the back end.
  • When denials are fewer, payments can be faster with growth in revenue, cash flow, decrease in patient billing errors and increase in  healthcare organizations time for patient responsibility.

 Denial Management with AI Healthcare Platform

  • Transforming denial management with AI
  • Saving costs and improving claim payments
  • Automatic web status verification
  • Automated pre-call analysis
  • Automated appeals writing
  • Security framework
  1. Transforming denial management with AI healthcare Services:

  • The AI healthcare platform transforms the whole denial process from end to end and increases the workflow.
  • It simplifies denial management process by using machine learning and automation technology which also actively learns constantly thinking and adapting far and beyond human intelligence.
  • It can also help in discovering insights by using advanced machine learning algorithms, deep learning networks, perspective as well as predictive modeling and applying these insights to the revenue cycle management processes.
  • AI healthcare also builds and optimizes user friendly interface for reinforcement guidance and self-learning.
  • The automated denial management process in AI healthcare platform is compatible with leading business
  • It allows a predefined configuration to automatically upload the claims and divides them according to the type of denial and age by enabling quicker turnaround time of denial follow up process.
  1. Saving costs and increasing claim payments:

  • An AI based analytics modeling tool reads and analyzes information from heterogeneous data sources, image files and documents.
  • AI technology gathers through the processor and provides insights on decreasing the claim denials and increasing future claim acceptance rates.
  • After extracting claim denials data, AI healthcare uses machine learning platform with advanced neutral network to develop predictive and prescriptive denial analysis.
  • The AI healthcare predicts up to 95% of the claim accuracy and probability of the claim denials.
  • It allows the medical billing team to take appropriate action before claims are submitted to the insurance companies.
  • AI healthcare technology also enables to classify the new denials and prioritize for re-corrections with guidance based on historic trends.
  • It also derives the root cause for denials using historic claim information and deep learning technology.
  • AI healthcare predicts claim denials status and provides solutions prior to claim submission.
  1. Automatic web status verification

  • The AI healthcare platform enables automatic claim verification status from payer portals.
  • DBPMS integration along with the practice management software is capable of pulling the required data like claim number, patient ID, patient name, policy number, date of service and the billed amount.
  • It improves the turnaround time for the claims with higher aging days by reducing potential revenue loss.
  1. Automated Pre-call analysis

  • PRA assists in creating an account or claim summary and claim history by reading and analyzing to determine the next step. This takes less time to complete the denial analysis process on an account.
  1. Automated Appeals writing

  • Usually on an average, analyst will spend 5-8 minutes of time for drafting the appeal letters that requires accurate and standard information such as claim number, processed date, payer’s name and address as well as denial type.
  • Personal Robotic Assistants (PRA) assists in gathering required inputs using AI healthcare platform by reducing processing time to 30%.
  1. Security Framework

  • AI healthcare platform provides ultimate security features that include static and dynamic analysis of code and manual pen testing.
  • Code security is measured using industry standard tools for security certification.

Don’t write off Claim Denials instead Use AI to automate appeals:

  • Staff training is very important to make better use of clinical decision support software.
  • Automate appeal process can strengthen and support claim process by preventing revenue loss for healthcare professionals or medical billing companies.
  • Automation process helps in examining thousands of claims and identifies how a successful claim is compared to a denied claim.
  • AI healthcare is trained to find missing documentation before claim submission by further communicating to adjust the gaps and reduce denial rates.
  • AI aids in cleaning up the old AR by following the claim automatically without any delay.
  • RPA process allows AI throughout the process and is capable of pulling evidence into a letter in less time.
  • AI healthcare stands as new support in the attempt to provide best healthcare services possible, amidst complex processes and realms of data to make the case for faster reimbursement or revenue paybacks.

Abilities AI healthcare provides Healthcare organizations

  • By assisting the medical billing team on claims by analyzing data in various stages.
  • Identifies and points out the route cause for claim denials.
  • Provides elaborated and detailed information on denial cause and process that impacts claim denials.
  • Making clear notes on the stages and reasons for the delays and denials for the claims.
  • Identifying the regions, providers and insurance that have highest denial rates.
  • Ensures timely submission of claims by improving turnaround time and efficiency.
  • Effective denial tracking and claim checking to verify accurate medical codes before submission.

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