New AI from Change Healthcare Can Assist Providers in Preventing Denials

Just today, Change Healthcare made an announcement that it has made an application of its Claims Lifecycle Artificial Intelligence (AI) technology to its claims management suite along with the introduction of Assurance Reimbursement Management Denial Propensity Scoring and Revenue Performance Advisor Denial Prevention. With performance improved by Claims Lifecycle AI, suppliers of any size can now actively notice problem claims which  could lead to denials, as well as remediate potential issues prior to when the claims are filed.

The AI within these applications can now assist customers to forsee denials, enhance claims submissions, and give actionable recommendations that allow providers to mitigate denials in a better way, prior to when a claim is tendered. The results can be very surprising.

Although studies have revealed that the most denials can be prevented, Change Healthcare’s analysis of 2018 data which spans above 500 million service lines revealed that Change Healthcare Claims Lifecycle AI had the ability to notice and flag up to 35% of denials before submission. This is a representation of $6.2 billion in forecasted enabled amounts and millions in potential administrative savings from reduced appeals and re-work.

The Change Healthcare Claims Lifecycle AI service has been trained on over 500 million service lines, accounting for over 205 million unique de-identified claims data, that were de-identified, in consistence with customer contracts as well as applicable laws, which touch $268 billion in charges, unparalleled in its scope. The service takes advantage of the company’s Intelligent Healthcare Network data from over 2,200 payers, 5,500 hospitals/health systems, as well as across 900,000 physicians.

Claims Lifecycle AI for denials is currently activated within Change Healthcare’s claims management suite, which includes Assurance Reimbursement Management. These solutions take care of the claims management requires for the entire provider ecosystem—ranging from small to large practices, durable medical equipment providers, laboratories, and nursing homes up to health systems and hospitals.

In addition to this, channel partners making use of the Intelligent Healthcare Network from Change Healthcare will be able to reach these new claims management capabilities through the Change Healthcare API Marketplace.

CloudWedge