3 Efficient Ways to Streamline the Denials Management Workflow in the Healthcare Sector

The healthcare industry relies heavily on insurance claim settlements to generate revenue and provide top-notch patient care services. Whether running a free clinic, providing urgent care, or performing complex surgeries with the best medical equipment, financial stability plays a considerable role in the industry.

Denial of claims makes it difficult for healthcare organizations to operate smoothly and offer timely medical services. Therefore, having a denials management system in place is a necessity. An AI-powered efficient denials management workflow can aid in the progress of claim processing.

Common Claim Denial Reasons

Typically, a health insurance claim gets rejected because of the following reasons:

• Incorrect information filled on the claim form
• Expired health insurance policy
• Raising claims during the defined waiting period (mentioned in the policy document)
• Missing important documents while filing the claim
• Filing multiple claims for the single treatment received
• Delay in claim intimation
• Hiding previous illness information from the insurance provider
• Errors in medical billing and coding

These simple yet consequential mistakes lead to huge losses due to claim denials. The administrative staff is capable of resolving these errors and processing the claim. However, it causes them to under-utilize their valuable time. Moreover, there is a chance of recurrence of the same error or making new mistakes, leading to claim settlement delays. Reports suggest that, on average, nearly 20% of all claims are denied. Hence, having an AI-powered efficient denials management workflow in place is prudent.

Streamlining Denials Management Workflow in the Healthcare Sector

Lynk IDP (Intelligent Document Processing) is a cutting-edge platform that builds, trains, and deploys custom AI models to solve unique business problems such as denials management. Here are three efficient ways to streamline denials management workflow using Lynk AI IDP:

Automated Relevant Data Extraction

Filing health claims requires countless document submissions - policy documents, claim forms, medical reports, doctor's notes, medical bills, and more. Extracting data from these documents manually usually results in numerous errors and ultimately causes claim denial. Lynk AI IDP:

• Automates and optimizes the process of data extraction, classification, and analysis from structured and unstructured documents.
• Improves efficiency by automating repetitive tasks such as data entry, claim status checks, sorting, and filing.

Intelligent Appeals Generation

On receiving the Claim Adjustment Reason Codes (CARC) from the payer, the provider understands the actual reason for the claim denial. Based on this, they can appeal the denial only if it is appealable. Lynk AI IDP can:

• Analyze and highlight accurate reasons contributing to healthcare claim denials.
• Prioritize appealing unpaid claim denials having a higher likelihood of approval using ML (Machine Learning) to gain predictive insights.
• Automate filing compelling appeals (pre-filled forms) based on precedence.

Healthcare Claim Denial Prevention

Denial of claims causes a substantial setback on the healthcare RCM (Revenue Cycle Management). A well-structured denial management system not only identifies reasons for denied claims and makes automatic timely appeals but also helps prevent healthcare claim denials. Lynk AI IDP can:

• Work with large datasets to deliver high-performing solutions, such as collecting all the data relevant to claim denials and adjusting the existing workflows to prevent claim denials in the future.
• Leverage advanced analytics and pattern recognition to optimize denial management workflows.

AI-powered Denial Management System: Futuristic Approach for Healthcare Claims

Empowering providers with healthcare claim denial management using AI capabilities is the futuristic approach to streamlining the entire process. Claim denials have a massive impact on healthcare RCM and affect business as usual. With Next-Gen tools like Lynk AI IDP, the healthcare sectors benefit tremendously, as they solve problems like claim denial efficiently.?

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