AI-based system reduces claims denials for Community Medical Centers of Fresno

The provider saw a 22% decrease in one type of denial and an 18% decrease in another. Those improvements have resulted in more than 30 hours per week in eliminated work for follow-up staff.

For Community Medical Centers of Fresno, as with many other healthcare facilities, denials are a constant source of pain, and managing them is an ongoing struggle.

In roughly the last 10 years, payers have increased their delay tactics – one method has been to do that with denials, said Eric Eckhart, director of patient financial services at Community Medical Centers of Fresno.

"This increased volume translates to an increased workload for my team," he explained. "We knew that many of our historical workflows were not efficient enough to handle this new level of denial volume. This situation led us to start seeking out new systems we could implement internally or ones that involved a vendor-based system.

"For the last five years, we have been on a journey to put the team in the best position possible to succeed by streamlining staff reporting structures, improving denial reports, updating EHR workflows and eliminating paper processes," he continued. "In addition, there has been an increased focus on preventing denials upstream."

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