3 Costly Claim Denials—And How Human Expertise and AI Can Fix Them
Claim denials remain one of the vast threats to the revenue cycle of healthcare, as the providers do not get paid on-time for the services they rendered when the claims are being rejected by the insurance companies. But few reasons for claim rejection are incorrect code, eligibility errors, etc). In this case, combining a skilled expert with ai results in the optimal elimination of the claim rejection. Â
1. Eligibility & Coverage Issues
Improper verification in the insurance eligibility leads to denials. This is one of the causes for denials that occur frequently. The fix: As of now with AI, the eligibility checks can be done in advance. Where the conflict at the time of claim approval is being eliminated.
2. Coding & Documentation Errors
Incomplete documentation and coding errors will lead to quick denials and delayed payments. The fix: AI powered coding tool helps to identify the missing or incorrect codes and suggest the accurate codes and validate it for the final submission with a motive of claim approval.
3. Prior Authorization Failures
Even for necessary procedures, prior authorizations are required. Incorrect or missing prior approvals will result in claim denials. The fix: AI has the capacity to probably predict authorization requirements and automate workflows, while on the other hand staff ensure in handling the documentation correctly.
The Takeaway
For creating a smarter move with accuracy in the workflow, both the expert human source and AI is combined for proper revenue cycle management. Instead of reworking on the claim denials, making it approved in a single stroke is far more efficient for the workflow and improves the overall experience of the patients and the healthcare.
