The lack clean claims is proving to be a catalyst in threatening provider’s livelihood. It is one of the primary reasons leading to increasing claims denial problem. It is also contributing to the extension of A/R days. What is most important to understand is that it cannot be fixed by humans. How do we know? We have been trying for over 20 years. But, it can be fixed by an AI based auto coder.
Solving the costly and manual process of healthcare coding.
Why the problem exists
The AI auto coder is an intelligent system of engagement that provides a solution to the combinatorial math problem – capable of evaluating a claim based on a seven to ten factor analysis, resulting in over 6.1 billion combinations of codes and modifiers, and then applying the right ones for ICD-10, CPT, and HCPCS.
These codes are then systemically applied to the correct claim form (e.g. 1500, UB04) that can be routed internally for other approvals or coding (e.g. charge master) or dropped directly to the clearing house for immediate processing to the payers.
The system can also read and evaluate an 834 form in order to assess and apply codes based on a patient’s policy coverage. The auto coder was initially trained with 50 million adjudicated claims and one of the largest data dictionaries in the industry. MVP-1 was delivered with 89% accuracy of coding.
As the product works through its MVP stages, the system will become smarter as a result of being trained with 4 to 6 billion records and is expected to reach 98% coding accuracy.