Meet Our RCM AI Assistant: A Solution to Better Claim Management Outcomes

Once upon a time, you might have imagined Artificial Intelligence (AI) as a scientific tool of the future, assisting us with everything from cooking dinner to driving cars. But AI is no longer an imaginary tool; it’s now actively being used in healthcare. AI can assist medical professionals with everything from diagnosis and treatment to simplifying work processes, including care plan creation, billing workflows, visit documentation, and so much more.

As of 2023, the FDA has approved up to 171 AI and ML-enabled medical devices, which will only continue to grow.

As a reminder, AI is a field of computer science that focuses on simulating human processes, such as learning, problem-solving, and reasoning, while Machine Learning (ML) is a branch of AI, where computers can learn from data and improve performance on tasks without being programmed to do so. If you want to learn more, read this article on the different subsets of AI, and why you shouldn’t be afraid to use it.

Navigating the Complicated Claim Management Process

Billing an insurance company has many moving parts, including the patient’s insurance plan peculiarities, the payer’s claim submission guidelines, and the agreement between the provider and the payer.

You know there’s a never-ending list of possible problems you may encounter when handling medical claims. Oftentimes there’s inaccurate patient information entered into a claim or there’s difficulty ensuring that procedures and diagnoses are coded correctly. Sometimes claim submissions are late or inaccurate, and you end up dealing with claim denials and time-consuming bouncebacks (the process for correcting and resubmitting rejected claims).

When these problems arise, your medical practice loses time and money. However, AI can help your healthcare organization oversee the complex medical claims process, and we know how.

As AI develops and improves, so do we. Remedly is proud to announce our AI tool: RCM AI Assistant. This new tool is built with you in mind; we want to make your work easier, better, and faster.

What is Remedly’s RCM AI Assistant?

Our AI Assistant is a new feature in our RCM. Trained on our software’s claim data, Remedly’s AI Assistant uses machine learning to predict the acceptance or rejection of claims by clearinghouses and insurance companies before submitting them.

What Are the Benefits of Remedly’s AI Assistant?

Our AI tool minimizes claim rejections and reduces bouncebacks. This ensures a smooth and timely reimbursement process, saving both time and money.

How Does It Work?

Our RCM AI Assistant streamlines your workflow. It works automatically within our system and goes through the following steps:

1. After you generate a claim, it undergoes internal scrubbing. If the claim passes the scrubbing, the AI instantly analyzes the data and predicts whether the clearinghouse or payer will accept or reject it.
2. If our AI detects a problem, you will see the “AI Declined” label. You will need to edit the claim; the AI Assistant will analyze it and then display an updated prediction.
3. If it doesn’t detect anything, you will see the “AI Approved” label.

What to Do if You Get the “AI Declined” Label?

You don't have to worry about it right away. The "Decline" label doesn't guarantee rejection but will help you recognize potential discrepancies. You can take the following steps to avoid receiving the “AI Declined” label:

• Double-check the patient’s data for accuracy and completeness. For better results, use Remedly's Eligibility feature to confirm the patient's details and insurance coverage.
• Before you submit the first claim, confirm if you enrolled for electronic submission with your payer through the clearinghouse.
• In the claim, ensure you select the Insurance Company that accepts electronic claim submission.
• Validate that the patient’s age or gender corresponds with the services and that the services are relevant to the specified diagnosis in the claim.
• Double-check the provider information in the Appointment Details.

Does the AI Assistant Guarantee 100% Accuracy?

We cannot guarantee 100% perfect results; however, our system has two processes (internal scrubbing and AI Assistant) to help you check for errors and ensure an easy and stress-free claim management process.

Smooth Claim Management Process with Remedly’s AI Assistant

Our RCM AI Assistant will help you recognize potential discrepancies and avoid costly claim denials or rejections, saving you time, money, and stress. Because we are devoted to our customers, we are confident that our new AI Assistant will increase the chances of successful reimbursem.