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Change Healthcare Says AI-Based Claims Software Could Reduce Administrative Burden


The tech could help providers identify problem claims prior to denial.

claims data

Photo/Thumb have been modified. U.S. Air Force photo by Senior Airman Susan Roberts.

Change Healthcare today announced the application of its artificial intelligence (AI)-enabled technology to its claims management suite, which the company said could improve patient satisfaction and help reduce administrative burden caused by claims denials.

Change Healthcare applied its Claims Lifecycle AI to its claims management suite by introducing Assurance Reimbursement Management Denial Propensity Scoring and Revenue Performance Advisor Denial Prevention. The company said these tools help provider organizations by using AI models to predict claims propensity and identify denials before submission.

“We took millions of claims to train the models and enable them to make predictions so that when it sees a new claim, it can pick up on the pattern of whether it is likely to be denied,” Jason Williams, vice president of data analytics and AI at Change Healthcare, told Inside Digital Health™.

An estimated 15 to 20% of initial claims submitted by providers are subject to denial.

Claims denials can be appealed and recovered, but healthcare providers don’t expect to take more time out of their already busy day to resubmit a claim. Providers prioritize how they work through appeals, but they don’t have enough help going through denials.

Change Healthcare’s AI models categorize claims and identify why they are going to be denied.

The solutions address administrative burden because they constantly run in the background of the software on which it is installed, serving as a warning condition for providers. They don’t need to be trained to look for anything new — they just see new content indicative of denial conditions before filing a claim.

Williams said the tool can also increase patient satisfaction. Reimbursements require a lot of back and forth, and it can create friction with providers.

“The cleaner the process can work, the more time and efficiency is saved in the revenue cycle, which can potentially allow for more overall patient revenue to be collected,” he said.

Assurance Reimbursement Management can be used for hospitals, health systems and billing services. Revenue Performance Advisor can be used for physician practices, labs, home health and medical billing services vendors.

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