We’re continuing to look for ways to improve Prochant Pulse, our proprietary technology platform, so we can continue to stay at the forefront of innovation in revenue cycle management (RCM). To that end, we're excited to introduce several recent AI-driven enhancements for denials and appeals management through our AR Efficiency initiative that will improve the way our clients manage accounts receivable (AR) and drive efficiency. These updates are designed to increase collections, reduce Days Sales Outstanding (DSO) and streamline workflows, making our team more effective.
AI Denial Insights
Our first enhancement focuses on data collection and AI integration to better track and predict denials. Our AI foundation includes tools like PDF reading, decision support for working denials and claim scrubbing to predict denial likelihoods before submission. Some of these tools will include:
- Virtual On-the-Job (OJT) Buddy: Uses AI to create best practice guides for the top 8-10 denials for quicker resolution.
- Appeals Assistant: Leverages AI to identify the right documents needed to support appeals to save time and improve quality.
- Denial Prediction: Utilizes historical data to predict the likelihood of a denied invoice being paid if worked as an input to prioritizing invoices for allocation.
Guided with AI-driven work aids, these enhancements are designed to support workflow efficiency and accuracy.
Appeals Wizard with Automation
Appeals management is a critical component of AR, comprising 10-15% of what we do, and we've made it more efficient with a structured workflow integrated into Pulse. Previously, managing appeals required switching between multiple systems to gather patient and insurance information, and lacked templates, often leading to disjointed efforts. Now, with a four-step "Appeals Wizard,” all necessary tools are in one place:
1. Input payer denial codes, HCPC codes and patient and insurance information.
2. Construct PDFs with relevant documentation.
3. Fill out insurer-specific appeal templates.
4. Automated transmission of the appeal via fax, print or portal.
This update has shown preliminary results of a 33% reduction in time spent on creating appeal packets, from 12 minutes to eight minutes, while also improving success rates for acceptance thanks to a more structured and consistent approach.
These enhancements to Prochant Pulse mark a significant step forward in our commitment to AI integration, innovation and AR efficiency in order to increase collections, reduce DSO and improve overall performance.
Stay tuned for more updates as we continue to innovate and enhance Prochant Pulse.
Interested in seeing a demo of Prochant Pulse? Fill out the form below to schedule your personalized demonstration and discover how we can help transform your revenue cycle management.
Prochant is the only AI-driven reimbursement service provider in the home-based care industry. We deliver focused revenue cycle management (RCM) solutions to healthcare providers with 7 wholly-owned global delivery centers. Our expertise lies in providing end-to-end RCM for home-based care, infusion, and specialty pharmacies, consistently delivering exceptional results to some of the leading healthcare providers in the country. We harness specialized automation technology and deep industry knowledge to streamline the time-consuming and expensive reimbursement process. As a result, we help healthcare providers accelerate their collections, increase revenue, and reduce operational costs while managing risk. Prochant is HITRUST certified, the gold standard for HIPAA security. For more information, please visit prochant.com.