AI-Generated Justifications for Denied Claims
Challenges
- The provider faces roughly 6% insurance reimbursement denials annually, creating revenue leakage, manual operational load, and delays in cash collection.
- Internal complaint justifications are drafted manually, consuming expert time and creating delays.
- Inconsistent quality of those comments increases denials, write-offs and lost revenue.
Approach
The model works from the supporting information already in the original claim — diagnoses, activities, service details — and drafts the resubmission comment.
Drafts go to a person for review, with clear justifications behind each one, so the expert decides and the model does the writing.
Key features
- Draft resubmission comments generated from the original claim
- Clear justifications attached to support the reviewer's decision
- Comments generated within the defined character limit
- A person reviews every draft before it is filed
Impact
Net Denial Rate improvement
As stated in the company deck
Productivity gain
As stated in the company deck
Working capital reduction
As stated in the company deck