AI-driven claim approval prediction, diagnosis support & scoring analytics
Predict claim approval with precision. Leverage AI to evaluate symptoms and patient history, aiding in diagnosis, procedure recommendations, and necessary investigations. Score each decision for accuracy and ensure higher chances of claim approval.
Enhance decision-making and reduce claim rejections with intelligent insights.
Why choose RCM AI
Ensure accurate evaluation of claims prior to submission for reduced rejections via our AI that factors in multiple parameters such as the diagnosis, possible lines of treatments, investigations and procedures.
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The module also hosts a variety of other features such as eligibility checks, medical coding, payment collections, etc.
Smart Claim Filing
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Universal Claim Format
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Medical Coding with ailment code, line of treatment, department, and procedure
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Compatible with the latest compliance layers such as HL7, FHIR, NHCX, etc.
AI Assessment
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Acceptance score percentage to determine confidence of claim acceptance
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Auto-suggestion of potential diagnoses, investigations, and procedures
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Smart interventions to aid doctors in probing patients during treatment to improve acceptance chances
Key Features
Medical coding
Auto Assignment of medical codes to claims for faster processing at the TPAs end. This ensures that vast medical coding resources are bypassed and adjudication is made easier, leading to cost savings and reduced TATs
Investigation, Procedure and Diagnosis Intel
AI engine that can understand a case and determine appropriate diagnoses from which requisite investigations and procedures can be suggested. Additionally, a confidence of acceptance and suggestions in the form of investigative questions to probe for symptoms or PEDs increasing the chances of claims acceptance is provided.
Bill Assessment AI
Assessment tools to detect errors or wrongly generated bills and raise the concerns to the handler. This ensures faster, error free bill processing in context of reducing denials and disallowances.
Eligibility Checks
Instant preliminary eligibility checks to determine whether the patient is available for any benefits and what extent of benefits are can be determined in advance.
Claim Acceptance AI
Smart platform with eRx to capture case details and provide a confidence score of acceptance of a claim during adjudication. This can serve as a useful guideline for appropriate advance collaterals from patients.
Payment Management
Instant review of outstanding analysis of receivables with aging analysis in a suave digital cockpit, ensures you are always on top of your finances. This comes with additional tools to compute complex doctor payouts in a single click.
Who benefits from RCM AI
Hospital Management
Critical administrative and financial oversight that doesn’t exist in current frameworks s made available instantly, without any dependencies on teams.
Doctors
The AI fed insights into patient treatments, diagnosis and investigations provide real time access to alter the direction of the treatment, while simultaneously ensuring a higher strike rate of claim acceptance. This quality assurance layer ensures that doctors can focus on their core responsibilities, while having us take care of the documentation and compliances with no additional hassle.
Insurers/TPAs
Common claims format and regulatory protocol claims, shrink the processing TAT significantly. This is due to the addition of an ICD code by the filing hospital prior to receipt of the claim by the adjudicator that makes the entire pipeline automatable and scalable ro new dimensions. Customer satisfaction is an inevitable byproduct.