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Knowledge is the lifeblood of AI, mentioned Sundar Shenbagam, chief expertise officer at Edifecs.
The problem is having a uniform strategy to acquire the information and keep it to ensure it stays safe. As soon as that is established, knowledge will be managed to give you an AI mannequin that automates among the quite a few time-consuming payer features.
Nevertheless, AI stays an assistant, not a alternative, to human decision-making, Shenbagam mentioned.
For extra on how AI will help payers, take heed to Shenbagam’s dialog with Susan Morse, government editor of Healthcare Finance Information.
Speaking factors:
- Unstructured knowledge, corresponding to prescriptions and lab paperwork, covers 85% of the healthcare knowledge being exchanged at the moment.
- Interoperability at Edifecs signifies that when knowledge flows, it’s collected, securely saved and uniquely pluggable into an AI framework.
- AI for well being plan administration can be utilized for member enrollment, claims, claims adjudication and all different duties that contain tons of paperwork between supplier and payer.
- The burden on well being plans is ever growing.
- A lot of information has errors and error correction is a large administrative burden.
- Utilizing AI, programs can turn out to be extra environment friendly.
- For prior authorization, a considerable amount of knowledge will be collected into one request as a substitute of getting a human extracting the related knowledge.
- Prior authorization can circulate in minutes as a substitute of weeks, but it surely does not change people.
- AI is assistant performance relatively than alternative performance.
Extra about this episode:
Claims denials on the rise, complicating income assortment, survey finds
Hospitals are leveraging AI to enhance income cycle
Finance leaders stability AI funding to anticipated ROI
Healthcare AI requires rigorous monitoring, says knowledge scientist
AI doctor assistant Suki takes over the executive burden
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