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We use computer intelligence to automate claim management process and make it readily available as cloud service with zero configuration. Using AI augmentation improves human productivity and helps avoid or recover 30-60% denials that could not be recovered before
Computer Intelligence for Managing Medical Claim Denials
PINNACLE SERVICES CORPORATION
Getting paid by insurance companies is a major problem for medical service providers. With constantly changing insurance payment policies and Medicare rules, service providers can lose 20% - 50% of revenue due to medical claim denials.
Most of these denials can be recovered and avoided if the denial is predicted at the time of order. Our predictive analytics and Computer Intelligence platform helps predict and avoid claim denials, collect more payments and reduce the cost of billing for medical service providers of any size.
LEARN
Our PayPredict Learning Engine is meticulously sifting through historical data exchanged between the provider and payers and learns every detail about:
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Insurance payment and denial rules
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Reimbursement rates and Expect Fees
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Claim refiling success rate
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Timely Filing Limits
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Order volume trends
APPLY
Our Web Applications use the knowledge to boost the productivity of denial management process and help humans to:
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Focus claim follow-up process on high-value denials that are easy to fix
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Stay within Timely Filing Limits
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Track outstanding claims
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Alert about reimbursement trend changes
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Fix many problems automatically before sending the claim