Overview

AIP accelerates the validation and review of appeals for denied medical claims by Appeals Coordinators and Medical Professionals.

Appeals Coordinators use AIP to screen lengthy, non-standard appeal PDF documents for information completeness, with AIP leveraging approved rubrics and cross-referencing existing sources of truth for claims. By being able to review extracted data elements with citations instead of having to repetitively navigate lengthy documents, Appeals Coordinators are able to increase their throughput and accuracy during appeal intake.

Appeals Coordinators and/or Medical Professionals can make informed decisions to uphold or overturn the appeal, based on AI suggestions in line with approved organizational policies. AIP compiles appeal responses based on organization-provided template letters and prepares the submissions for processing, streamlining the communication with the appeal originator.

Features

• Verification Assistant Inbox: Appeals Coordinators can easily review and edit essential data elements (e.g. claim id, receive type, urgency, etc.) in context, with direct references to the specific section within the raw appeal. The edits made, with updated citations, are tracked for future reviewers/auditors to reference, making sure valuable expert human context isn’t lost.
• AI Integrated Review Inbox: Appeals Coordinators and/or Medical Professionals can use AIP-guided insights to support their decision making on whether to uphold or overturn the appeal. After these users make the final decision, they can work off an autogenerated letter draft using already approved, org-specific templates, reducing their administrative burden and further streamlining the appeals lifecycle.