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Preventing and appealing clinical denials with analytics, automation, and AI

U.S. hospitals lose $262 billion due to denied claims each year, representing 10% of the total claims paid. Unraveling the root cause of denials costs an average of $118 for each claim. Applying modern technology — such as analytics, automation, and artificial intelligence (AI) — can help to increase the number of clinical denials investigated, boost appeal effectiveness, and unearth root cause.
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Member experience: Never a better time for digital enablement

Health plans are all too familiar with the challenges of member…

Precision utilization management: Meeting patients where they are

Providers view prior authorization as a manual, burdensome, and…
claims paperwork upon receipt

Re-engineer, automate to avoid claims errors

By Manjunath; Practice Lead, Claims Adjudication; HGS Healthcare…

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