Remedly AI Assistant is a new feature in the RCM that predicts whether the claim is likely to be accepted for processing by the clearinghouse/payer, or rejected. It utilizes Remedly's own proprietary machine learning model, developed within a dedicated neural network infrastructure. The model is trained on real historical claim data and acceptance responses from clearinghouses/payers.
AI Assistant helps detecting and addressing potential issues prior to claim submission, thereby minimizing the risk of rejection and reducing the bounceback (an iterative cycle where you correct and resubmit a claim following rejection by the clearinghouse or payer due to some high-level discrepancies or errors).
1. Once a claim is generated in Remedly and successfully passes the internal scrubbing, AI Assistant conducts an instant background analysis of the claim data to predict its acceptance or rejection by the clearinghouse/payer.
2. After each edit made to the claim or any of its sections, Remedly AI Assistant will re-run analysis in the background to show the updated prediction.
3. On the claims list, next to the claim status, you'll find an AI Approved or AI Declined label:
4. Same inside each particular claim:
5. Remedly AI will analyze the claims in the Not Submitted or Not ReSubmitted statuses. For the claims in other statuses, you'll see the last-received prediction.
AI Assistant only shares a prediction to help review and address potential problems proactively. If you notice a Declined label, consider reviewing the following areas to ensure the validity and completeness of your setup and claim data:
- Ensure that electronic claim submission is supported by the selected Insurance Company (payer) in the claim.
- Verify that you have enrolled with the payer for electronic claim submission through your clearing house before submitting your first claim.
- Confirm that the patient's data is accurate and complete. You can validate insurance coverage and patient details like DOB by running an eligibility check in Remedly.
- Ensure that the rendered services correspond to the diagnosis and are relevant for the patient's age/gender.
- Check that the Appointment Details section contains correct provider details.
Please note:
Neither AI Approved, nor AI Declined label guarantees that the claim will be accepted for processing, or rejected by the clearinghouse / payer.
If all claim details appear intact and no issues are detected upon review - no worries! Simply proceed with submitting the claim as is. You'll receive a more detailed response from the clearinghouse or payer in case of any discrepancies.
Stay tuned for more exciting features, in-depth analytics and sophisticated recommendations to come as we continue enhancing Remedly AI Assistant's capabilities!
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