Change Healthcare rolls out new AI tech to help reduce denials

The tool can help health systems optimize submissions and better predict potential issues with claims, the company says, giving recommendations to help mitigate denials before they're submitted.

Change Healthcare, developer of analytics technology for value-based care, has launched a new AI-powered tool to help providers more proactively spot potentially problematic claims – and fix issues that could otherwise cause denials.

The new Assurance Reimbursement Management Denial Propensity Scoring and Revenue Performance Advisor Denial Prevention technology is powered by Change's own Claims Lifecycle artificial intelligence.

The AI will enable health systems to better predict denials and optimize claims submissions, the company says, and will offer recommendations to help them mitigate denials before claims are submitted.

Change notes that its Claims Lifecycle AI algorithms have been trained on a large scale – on more than 500 million service lines, with more than 205 million pieces of unique de-identified claims data touching some $268 billion in charges.

"Bringing all of these capabilities together and preventing a significant burden is a real game-changer for revenue cycle management, which, until now, has been a more retroactively focused process," said Marcy Tatsch, Change Healthcare's senior vice president and general manager, revenue cycle management.

Change Healthcare – whose value-focused efforts in recent years have included telehealth partnerships and blockchain initiatives – says it has research from 2018, across more than 500 million service lines, that showed its AI could identify and flag as many as 35% of preventable denials before submission – that represents $6.2 billion in forecasted allowed amounts, the company says, could offer providers significant efficiency savings from reduced rework and appeals.

"We continue to build powerful AI solutions with accuracy on the foundation of our Intelligent Healthcare Network," said Nick Giannasi, executive vice president and chief artificial intelligence officer, Change Healthcare. “Making these AI-infused solutions available in the workflow of existing Change Healthcare solutions means that providers don’t need to purchase additional third-party applications or services, undergo training, or change their billing solutions to quickly reduce denial propensity."

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