3 Professional Benefits of Integrating AI in Claims Management

  • Written by Ashley Mark
  • Friday 6th October 2023
3 Professional Benefits of Integrating AI in Claims Management VLMS Healthcare

Artificial intelligence is booming all around the world in different industries. It seems to be the ruling future for various businesses and sectors. But its scope is much higher than it appears to be. AI has revolutionized many industries, including healthcare also. It has transformed how healthcare providers handle healthcare claims management in the healthcare industry. The claims process is a complex and time-consuming process that requires special attention and approach. 

Denied claims always result in lost income and revenue. Whenever a claim is rejected, the healthcare provider loses the income and payment for their provided service. Healthcare claims management sometimes becomes an unsustainable financial drain process for healthcare providers, and providers are only left with the option to push these costs back to patients. Integrating AI for claims management comes with numerous benefits. Healthcare providers need to implement AI with claims management to avoid the risk of losing millions of revenue. Using predictive analytics software in AI claims management helps providers enhance reimbursement and improve cash flows. 

Role of AI in healthcare claims management

The process starts with the patient's visit to the hospital. One patient claim could go through 20 or more checkpoints before payer approval reimbursement. Denied claims are low in the number of payments, and most hospitals today face claim denial increasingly. The three most common reasons for medical claim denial includes:

  • Inaccurate medical coding
  • Incomplete or missing prior authorization
  • Failure to verify provider eligibility

Without any doubt and second thoughts, providers must employ trained staff to submit claims without any errors. Providers need accurate patient data with a standard verification process at every step. Healthcare providers can quickly reduce and even completely eliminate common reasons for claim denials by employing artificial intelligence in claims processing. AI claims management systems offer learning for staff by presenting claims management errors at first before submission and the possibility of rejection by the payer.

Benefits of using AI in claims processing

AI and automation are the two key starters that can kickstart effective healthcare claims processing. With the implementation of artificial intelligence in claims processing, providers can track and manage claims denials even before they occur. Predictive denials are a tool that prevents bad claims from being converted into costly denials. This artificial intelligence healthcare claims management system works in two ways:

  • By efficiently identifying undocumented payer adjudication rules that can result in denials.
  • Identifying claims with the high possibility of an organization's historical payment data.

Sometimes, claims make it through but get denied by payers. Denial management can be a lengthy, time-consuming process that directly affects cash flow. Artificial intelligence uses advanced algorithms to bifurcate denials based on their potential value. This allows billers to focus on high-value claims first to maximize the revenue cycle and minimize the denial numbers. AI in the reimbursement process spikes the speed of healthcare claims management to help staff quickly identify which claims need attention without wasting time on low-value claims. By operating with automation and AI, healthcare providers can attain better insights into their claims status and denial data. This approach results in improved financial performance and high efficiency.

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