Denied! The State of Claims in 2024  Experian Health’s survey of 210 patients and providers shows that claim denials are still a big problem in 2024. The survey found that 38% of claims are denied at least 10% of the time. It means it is a regular problem. The survey also found that 11% of […]

Introduction  Healthcare providers face a common challenge in managing complex policies. These policies can be for insurance claims, regulatory compliance or internal healthcare guidelines. All are time-consuming and prone to errors. The major drawback is that policy navigation adds an administrative burden on medical staff which affects patient care. Furthermore, it adds operational costs ranging […]

Introduction Unsolved claim denials are a common issue in the healthcare industry. On average, denied claims cause hospitals an annual loss of $5 million, representing up to 5% of net patient revenue. The major drawback behind this revenue loss is the cumbersome traditional outdated healthcare appeal process. Creating appeals requires the manual effort of writing […]

Claim denials in healthcare are becoming a critical issue for healthcare providers. Providers deliver patient care and expect timely reimbursements in return but when these claims get denied, they not only get frustrated but suffer financial losses, operational hurdles and strained relationships with payers. AMA reported that nearly 15% of claims submitted to private payers […]

Introduction  The healthcare industry is huge and complex. One major issue is managing claim denials, which can severely impact providers’ financial stability. High denial rates increase administrative burdens and reduce operational efficiency. Recent advancements in technologies have transformed healthcare from denial to approval. Machine learning integration in healthcare changed the way insurance claims were managed. […]

Overview Imagine this: your team spends hours manually sorting through insurance policies, trying to decode the fine print just to determine medical necessity. With policy complexities growing and denials piling up, how much revenue is slipping through the cracks because of administrative delays? What if there were a smarter way to manage policy details, streamline […]

Overview As revenue cycle leaders face increasingly complex financial complexities, preventing healthcare claim denials has become a top priority. The State of Claims 2022 report by Experian Health reveals that 30% of respondents experience claim denials 10-15% of the time, while 42% have seen the rate of denials increase year over year. These often-avoidable denials result […]

Overview Having high volume of healthcare appeals in backlog is like leaving money on the table. This statement could be correct before the AI powered solutions get into the game. Generative AI has played so well in tech industry but now it is getting popularity in order to streamline complex processes within healthcare RCM. Most […]

Overview Ever received a denial from your health insurance company, leaving you confused and frustrated about medical treatment coverage? This can be especially concerning when the denial is based on medical necessity. Rest assured, you are not alone navigating health insurance policies can be a frustrating and often confusing experience for healthcare providers, especially when […]

Overview Healthcare professionals often need help navigating the complex healthcare policies, which are filled with technical jargon, legal terms and continuous changes. Fortunately, the introduction of generative AI (Gen-AI) is transforming how healthcare professionals can access and comprehend payer policies. This advancement is leading to improved efficiency and better patient care. In this blog, we […]