BILLING.AI automates the end-to-end claims submission process, leveraging artificial intelligence to learn from historical payer denials and approvals. This intelligent automation aims to significantly reduce claim denials, with reported reductions of up to 40% within 12 months of go-live. The platform also provides a comprehensive analytics dashboard featuring over 140 detailed reports, offering critical insights into a provider's financial operations. The solution tackles manual processes that often plague medical billing workflows, leading to revenue leakage. It automates the entire medical billing process, encompassing charge entry, eligibility verification, denial prediction and prevention, claim preparation, claim submission, adjudication, response parsing, and A/R redirection. By identifying key trends through its best-in-class billing analytics module, BILLING.AI empowers providers to take proactive action, prevent costly billing mistakes, and streamline the cumbersome claims submission process. This automation ultimately helps providers get reimbursed more quickly, improving their overall bottom line.

Features & Benefits

• Extensive Interface Capabilities
  • Enables the import and normalization of patient data into the billing system, supporting various file formats including HL7, JSON, and XML.
• Automated Data Error Classification
  • Automatically classifies data errors into various buckets for auditing discrepancies.
  • Missing demographic information
  • Missing coding information
  • Missing insurance information
• Charge Entry Automation
  • Automates charge entry with specialty-based classification.
• Automated Claim Adjudication
  • Carries out claim adjudication based on various factors, including comprehensive eligibility verification and coding validations.
• Eligibility Verification:
  • Validates co-pay, co-insurance, procedure eligibility, place of service, specialty, and in/out of network eligibility.
• Coding Validations:
  • Includes gender-specific procedures, age-specific procedures, medical necessity, maximum units, procedure corresponding to DOS and POS, procedure modifier, CCI, add-on procedures, LCD and NCD, applicable diagnosis and sequencing, and NPI.
• Denial Prediction
  • Adjudication outputs contribute to the prediction of a denial score on a scale of 1-10, indicating the likelihood of a claim denial.
• Automated Claim Preparation and Submission
  • Automates claim preparation in 837 format and submission to clearinghouses and payers.
• Automated Payment Posting
  • Automatically parses 835-formatted responses and posts payments to respective claims in the billing system.
• Denial Reduction Opportunity Identification
  • Analyzes remark and remit codes from 835 responses to classify claims into specific denial-resolving opportunities.
  • Authorization
  • Billing
  • Coding
  • Contractual
  • Duplicate
  • Eligibility
  • Medical Necessity
  • Miscellaneous
  • Non-covered
  • Patient Responsibility
• Automated A/R Redirection
  • Automatically redirects claims that are eligible for Accounts Receivable (A/R) to A/R management processes.
• Extensive Billing Analytics Dashboard
  • Provides real-time insights (140+ types) into claims data and identifies opportunities to reduce denials.
  • Financial summary dashboards
  • Dashboard for claims in A/R
  • Denial category and error category dashboards
  • Statistics by payer and provider
  • Highest dollar claim denials
  • High frequency denials
  • Top denial reasons
  • Top denials by payer
  • Top denials by specialty
  • Reclaim rate
  • Claim-level denials
  • Payment analysis
  • First-pass rate for claims
  • Claims aging summary