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The Role of AI in Simplifying Healthcare Claims Processing

FREMONT, CA | Thursday, April 29, 2021

While claims processing and reimbursement are an important part of the healthcare revenue cycle, there are many stakeholders and steps involved, including authentication, justification, authenticity, and payment

Fremont, CA: Since the pandemic has had such a negative effect on healthcare institutions' financial well-being, they're rapidly turning to digital and (AI) solutions to optimize behind-the-scenes operations and reduce administrative and operating costs. These investments in departments and functions that require error-prone, repetitive, time-intensive activities are yielding immediate results in many hospitals. Claims processing and reimbursement is one feature that is rife with such tasks.

While claims processing and reimbursement are an important part of the healthcare revenue cycle, many stakeholders and steps are involved, including authentication, justification, authenticity, and payment. Each phase is just as important as the last, so effective and accurate communication among all stakeholders is important.

Most hospitals are using AI options to simplify the claims processing and reimbursement process. AI automates these critical but routine tasks to reduce mistakes, optimize workflows, and free up hospital staff to focus on more complex tasks that involve human interaction.

In terms of payment and claims management, hospitals are employing AI in various ways to outsource and automate routine, high-volume tasks, reducing employee workloads and speeding up the overall revenue cycle. With AI's precision, hospitals can eliminate the risk of errors in patient entry or pre-authorization statements and unnecessary back-and-forth communications caused by errors.

AI is being used to reduce the high costs associated with insurance coverage claim denials. Suppliers may use artificial intelligence to identify and minimize erroneous claims until the insurance company refuses payment. This speeds up the process and saves time for hospital workers who would otherwise have to work through the rejection and resubmit the claim.

Hospitals have more confidence in the timeline within which they would be reimbursed with faster funds and higher accuracy and are therefore more willing to consider a broader range of proposals. AI enables hospitals to embrace various plans, allowing benefits brokers to provide multiple options to their clients.

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