A sophisticated approach for simple outcomes

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.