Key takeaways:
- Manual work and disconnected claims management systems are often prone to errors, leading to delays and claim denials.
- Technology, such as automation and artificial intelligence, can help healthcare organizations predict and prevent potential claims issues before claims are filed.
- Implementing AI-based claims management solutions should be a top priority for revenue cycle leaders.
health care Claim denials are on the rise – but so is a new era of technology that can predict and prevent denials before they happen. Leveraging artificial intelligence (AI) for claims management can help organizations break the denial cycle and keep revenue cycles moving.
In this article, we will explore how solutions like the innovative one from Experian Health Patient Access Curator and AI™ Advantage are designed to help providers reduce claim denials with AI.
Explore how Experian Health is reshaping the way health systems manage benefits coordination. Discover how automation and AI are eliminating manual errors, reducing denials, and unlocking millions in recoverable revenue.
Updating healthcare claims management tools
Claims management is one of the most pressing challenges in healthcare billing. At Experian Health 2024 Claims Status Survey77% of providers said they were moderately to extremely concerned that payers would not reimburse them, largely due to changes in payer policies and prior authorization requirements.
Revenue cycle leaders know that good complaints management It is the key to healthy cash flow and a solid financial foundation. However, with increasing patient volume and complex rules for payers, traditional claims management solutions can no longer keep pace. As a result, today’s healthcare organizations are feeling pressure to update their claims management processes and adopt solutions that rely on automation and AI-powered analytics to better predict, prevent, and process denials.
Predict and prevent denials with artificial intelligence
Healthcare providers can stop the spiral of denial before it starts by capturing accurate and complete patient data at the time of registration. According to data from Experian Health, 46% of denials They are caused by missing or incorrect information. Now, many healthcare organizations are accelerating their digital transformations by implementing automation and artificial intelligence tools designed to predict and prevent denials.
Automation creates consistent workflows, standardizes routine tasks, and reduces human error. At the same time, AI takes claims management to the next level by predicting denials, flagging errors in claims before they are submitted, and prioritizing claims that need attention. Leveraging AI solutions that form a closed-loop system can ensure clean data at the time of registration while predicting and preventing denials.
Front-end solutions
Tools like Patient Access Curator Automatically find and correct patient data in seconds, across eligibility, Coordination of Benefits (COB) primacy, Medicare Beneficiary Identifiers (MBI), demographics, and insurance discovery. Machine learning and predictive analytics allow providers to identify and correct incorrect data in real time, without the guesswork.
Ken Kubisty, vice president of revenue cycle at Exact Sciences, shares how Patient Access Curator improved eligibility processes, reduced errors, and more.
Back-end solutions
Experian Health AI advantage uses artificial intelligence and machine learning to predict and prevent denials. AI advantage Not only does it predict claims outcomes mid-cycle, it also puts urgent tasks at the front of the queue, allowing staff to prioritize the claims that matter most financially.
Extending the automation advantage
TO minimize denials and delays, Providers can look to implement automation and artificial intelligence across the claims ecosystem. For example, Patient Access Curator and AI Advantage integrate seamlessly with solutions that manage the entire claims cycle, such as Experian Health. ClaimSource®— use real-time information generated by ClaimSource to detect patterns and predict future payer behavior.
Additionally, tools like Claims Debugger can automate the claims purging process, reducing potential errors, administrative burden, and the need for costly modifications. Organizations can also add a denials workflow manager to automate and streamline the denial management portion of the claims cycle, improve staff productivity, and accelerate reimbursements.
Artificial intelligence for claims management Frequently asked questions
Want to learn more about how Experian Health’s AI tools can help reduce and prevent claim denials? Consider these frequently asked questions.
AI advantage It works in two stages of claims management, with two offers: Predictive denials and Denial Triage. In the first stage, Predictive Denials uses artificial intelligence and machine learning to look for patterns in payer awards and identify undocumented rules that could result in new denials. This solution also detects claims with a high potential for denial, so the right specialist can intervene before claims reach payers. After a claim has been denied, the stage two component of AI Advantage uses advanced algorithms to identify and segment denials based on their potential value.
Experian Health Patient Access Curator is a robust patient intake and verification solution designed to eliminate errors that often result in denials, such as missing or incorrect information. Through artificial intelligence and robotic process automation, Patient Access Curator automatically verifies and verifies patient demographic information, insurance details, eligibility, and more, reducing claim denial rates and administrative burden.
Patient Access Curator and AI advantage form a closed-loop system that offers healthcare organizations a smarter, faster, and more scalable way to reduce denials and increase reimbursements while reducing the administrative burden on staff.
The bottom line: Providers can reduce claim denials with AI
Leverage artificial intelligence to claims management can improve the overall efficiency and accuracy of healthcare claims processing, resulting in fewer denials and a smoother patient experience. Instead of waiting for denials to occur before taking corrective action, healthcare organizations can stay one step ahead with claims management solutions that use artificial intelligence and automation. These tools can help proactively detect errors and diagnose weaknesses in the claims process for a healthier revenue cycle.
As Jason Considine, president of Experian Health, recently shared: “With the power of AI and predictive intelligence, we are no longer waiting for denials to occur; we are helping providers proactively prevent them. Tools like Experian Health Patient Access Curator and AI advantage Enable healthcare organizations to identify issues at the time of registration and throughout the revenue cycle, so teams can focus on care, not fixes. “It’s about working smarter, reducing risk and protecting income.”
Learn more about how Experian Health AI-powered claims management solutions Help healthcare providers improve reimbursement rates and reduce denials.
