While the healthcare industry has been trying to fix the claims denial problem for the past 20 years with various revenue cycle management solutions, the problem has persisted and the numbers continue to climb, presenting significant fiscal challenges to providers.
Determine the chance of healthcare claims denials.
What the problem looks like
Claims denials by region
Top reasons for claims denials
AI.io developed a white box, intelligent system of engagement capable of analyzing individual claims to cluster them with similar claims in order deliver a percentage chance of denial (e.g. 67% chance of denial). Once grouped, the system compares the individual claim to billions of similar claims to determine trends in the various groups (e.g. payer, diagnosis, coding, service not covered, additional documentation, untimely filing) the final adjudication of the larger set of claims in order to render a chance of denial of the original claim. Once the chance of denial is determined, the system will explain the results and make improvement suggestions resulting in a lower chance of payer denial.