In the last four years, providers saw a 23 percent increase in claim denials and the rate is increasing. Organizations have been trying to reduce claim denials by training staff on coding and billing processes, educating patients about medical costs, and investing in software that automates coding and insurance verification.
However, are we utilizing AI to yield the best results?
We can use AI technology with deep learning to predict denials before transmitting a claim.
Employers, government agencies and insurance companies provide patients with health insurance coverage needed to receive necessary health care services. Individuals can also purchase their own insuarnce coverage. The provider or the patient submits a medical claim to a payer to receive reimbursement for the services rendered to the patients. This claim has information about that incident otherwise known as an encounter which can beat a physician’s office, out patient facility, or an inpatient setting.
The medical claims data set from providing these services can be used to generate helpful insights about the usage of services, the frequency of such services, and what is paid, denied, or rejected.