Denial Management Solution

Data-Core Healthcare is on a mission to find a solution that would reduce the average denial rates to less than 5% and the average accounts receivable to less than 45 days. To this end, we have harnessed the strength of AI/ML to work in tandem with the traditional Rules-based approach to predict the probability and most likely reason for the denial of claims. Over 30 million In-Patient and Emergency Department claims data were analyzed to develop the Rules Engine and train the AI/ML models that form the core of this solution. A variety of denial reasons were studied, focusing on the ones most frequently encountered by providers.

Solution Workflow:

EOB to 835 Conversion Tool

With AI/ML technology and our data scientists’ expertise, we are now able to convert paper Explanation of Benefits (EOB) to EDI 835 files electronically to overcome the limitations of the manual posting of payments. This tool accommodates most of the EOB templates commonly used by payers.

Solution Workflow:

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