AI & ML
AI-Powered Claim Denial Prediction for a Regional Network
Implementing machine learning models to predict and prevent insurance claim denials before submission.
Main Impact
35% Increase in Revenue
Time Reduction
30% avg
Accuracy
99.9%
Security
HIPAA Grade
Overview
A regional healthcare network was losing millions annually to preventable insurance claim denials. We developed a custom AI model integrated into their billing workflow that flags high-risk claims based on historical denial patterns, allowing billing staff to correct coding errors before submission.
Key Results
Reduced initial claim denial rate by 42%
Accelerated the average payment cycle by 14 days
Freed up 30% of billing staff time previously spent on appeals
Generated a 35% increase in captured revenue within 6 months
Services Delivered
- Predictive model development for billing cycles
- Integration with existing Practice Management (PM) systems
- Automated claim scrubbing rules engine
- Custom dashboard for revenue cycle managers
- HIPAA-compliant data processing
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