BC Advantage - 2024 Issue 7

How Providers Can Use AI to Win More Claims Denial Appeals

Healthcare providers face so many concurrent financial challenges, including rising costs, labor shortages, and constrained capacity, that the amount of time and money they must expend on appealing claim denials is particularly galling.   For example, providers spent nearly $20 billion in 2022 on efforts to resolve delays and denials across payors. More than half of the total came from denied claims that were appealed and ultimately paid, according to a recent data analysis from Fierce Healthcare.   Additionally, denials are increasing, according to 73% of healthcare leaders, as reported in a Kaufman Hall report from last year. Separately...

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