HIT Consultant December 10, 2024
In recent years, payers have increasingly turned to artificial intelligence (AI) as a tool to streamline claims processing, accelerating the deployment of rules related to prior authorizations and medical-necessity assessments. Providers believe this has been a key driver behind a corresponding surge in claims denials, as well funded payers leverage technology to rapidly render these determinations and send them back to hospitals.
This trend has providers looking to respond with a tried-and-true strategy: Time to beat ’em at their own game.
Industry consolidation has given larger payers more capital to invest in payment-integrity technologies, including advanced algorithms and rules-based systems to systematically deny claims. Payers justify this approach as a response to “bad actor” providers who they believe order...
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