July 12, 2024

Thrive Insider

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Erasing Unnecessary Claim Denial with AI

Artificial intelligence (AI) has a lot to offer the healthcare insurance sector, especially when it comes to revamping the claims submission process to be more accurate and efficient. The traditional claims process currently has a lot of problems. Claims are getting denied left and right, which is amounting to $262 billion in costs annually. The patient registration phase is proving to be especially fickle, accounting for $71 billion worth of denied claims. A lot of the errors are driven by misidentifying information because it is not easily located on the insurance cards and relying on technology that is outdated. The OCR systems that are used to scour for patient identifying information can’t even read digital insurance cards, which are very common nowadays. 

AI might represent a way to fix these glaring issues. AI-powered insurance card capture systems, which have been trained on large datasets of payers and insurance plan types, are able to validate data accurately as quickly as five seconds. This is a massive improvement from the five to fifteen minutes that it takes a human employee to complete the same task. It is also much more accurate than the 19.3% error rate that human employees have contributed to. Lots of money can be saved from not having to resubmit these claims, which can cost $25 per resubmission.

The Smarter Way to Capture, Verify, and Process Insurance with an AI-Powered Solution
Source: OrbitHC