Denial management continues to cause financial burdens for many providers. Fortunately, the risk of costly claim denials can be mitigated with TriZetto’s Predictive Claim Outcomes™ solution. TriZetto uses advanced machine learning (ML) models to forecast the potential for denials to help practices improve revenue opportunities. Leveraging an artificial intelligence (AI) framework that draws from a database of hundreds of millions of matched claims and remits—including historic claim, payment and denial data—across all geographies, payers and providers, TriZetto’s Predictive Claim Outcomes solution provides deeper insights into potential denials. TriZetto’s Predictive Claim Outcomes solution can not only detect the likelihood of a denied claim, but can also give details on how to solve and prevent future denials by providing specific denial reason groups and codes. It also allows for custom risk tolerance levels which practices can use to fine tune work queues to ensure time is spent on claims with the highest probability of denial.
Learning Objectives:
Identify denial probability with ML and AI to secure proper reimbursement
Reduce administrative costs and back-end work through proactive intervention
Increase speed-to-payment by submitting cleaner claims
