Healthcare Providers Can Now Meet Claims Denial Challenges – Head-On With AI

Blog /Healthcare Providers Can Now Meet Claims Denial Challenges – Head-On With AI

With today’s ever-changing medical regulations, denials continue to eat away at the bottom line of provider organizations. According to the Healthy Hospital Revenue Cycle Index, approximately $262 billion in healthcare claims were initially denied in 2016 — an estimated 9% of charges. Failure to follow up on denied claims could be extremely costly. Including the cost of rework and the additional opportunity cost of resources reworking claims, how much does your organization lose annually? Do you face productivity loss as your staff rework claims?

While most of the denials are recoverable, wouldn’t it be profitable if you could simply prevent the denials and save the cost of reworking the denied claims? The reasons for a claim to be denied could range from administrative, clinical or financial factors. The issues can be resolved through root cause analysis. And the easiest way to create this analysis is to automate the denial management process.

NTT DATA Services AI platform ensures fast and problem-free reimbursement

The NTT DATA Denial Management Artificial Intelligence (AI) Platform uses machine learning and intelligent automation to simplify the denial management process. The intelligent platform actively learns, constantly adapts and evolves — far beyond human thinking and capabilities. It can help healthcare payers:

  • Gain insight, using advanced machine learning algorithms, deep learning neural networks, prescriptive and predictive modeling, and apply that insight into core business processes
  • Build and optimize prediction models, using an intuitive, user-friendly interface for reinforcement learning and self-guidance.

Our Denial Management AI Platform builds its neural network powered model, using the NTT DATA Robotic Context Processor to read and analyze information from heterogeneous data sources, image files, and documents. It then uses this model to provide insight and denial reduction guidance to increase the claim acceptance rate for future claims. The Denial Management AI Platform was selected as a winner of the Real World Use Case Study — Digital Transformation Success Story Category for this year’s 2018 Best Outsourcing Thought Leadership (BOTL) Awards.

Unlike other AI platforms available in the market that are primarily tool-based and require data scientists to operate, our AI platform is based on GUI and Automated Model Builder. It can be operated by domain experts like business analysts or subject matter experts.

Intelligent analytics enhance claim acceptance rates

Using dynamic computational intelligence, our framework performs advanced perception, forecasting and predictive analysis based on historical medical claim data drawn from heterogeneous data sources by detecting hidden patterns between data elements. This process provides denial reduction guidance and insights to increase claim acceptance rates for future claims.

Want to learn more? Email us to learn how you can automate denial management, and accelerate cash flow with:

  • Contextual predictions and forecasts based on historical data and future scenarios
  • Improved decision-making capabilities and by applying intelligent insights to data

Post Date: 15.10.2018

Harsh Vinayak

About the author

Harsh Vinayak is a senior leader at NTT DATA Services, leading the Offshore Operations for the Business Process Services line of business and the Global Shared Services Division. Dr. Vinayak has extensive expertise in designing and executing innovative solutions for wide-ranging issues — from complex outsourcing architecture, collections and recovery operations — to rotary wing vehicles. His background in advanced research and development positions him uniquely to provide clients with informed solutions based on extensive data analysis and forecasting.

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