Change Healthcare Unveils Claims Lifecycle Artificial Intelligence

ORLANDO, Fla., February 12, 2019, HIMSS19 Booth 3679—Change Healthcare today announced Claims Lifecycle Artificial Intelligence, a new capability being integrated into the company’s Intelligent Healthcare Network™ and financial solutions, to help providers and payers optimize the entire claims processing lifecycle.

This Change Healthcare Claims Lifecycle AI service is trained on more than 500 million service lines making up over 205 million unique claims that touch $268 billion in charges. The service leverages the company’s Intelligent Healthcare Network data from more than 2,200 payers, 5,500 hospitals/health systems, and across 900,000 physicians. Solutions and services across the Change Healthcare portfolio are using artificial intelligence (AI) to help customers with improving payment accuracy, reducing denials, enhancing payment forecasting, and reducing administrative overhead.

“Our strategy is to bring AI capabilities to the entire healthcare financial and administrative ecosystem, and claims lifecycle management is the logical place to start,” said Nick Giannasi, Ph.D., chief AI officer, Change Healthcare. “We’re using AI to bend the cost/quality curve of healthcare. By applying AI to our Intelligent Healthcare Network data, combined with our pervasive presence in payer and provider workflows, we are delivering new health IT solutions that help customers address the financial pressures from healthcare costs in ways not previously possible. Applying AI will transform the claims lifecycle process.”

The first three customer applications enhanced by Claims Lifecycle Artificial Intelligence are Change Healthcare’s Assurance Reimbursement Management™, Revenue Performance Advisor and Medical Network Solutions. The AI embedded in these applications helps customers predict denials, optimize claims submissions, and provide actionable recommendations that enable providers to better mitigate denials prior to claim submission. Additionally, customers using the Change Healthcare Intelligent Healthcare Network will be able to access selected AI capabilities via the Change Healthcare API Marketplace.

From 2018 data, Change Healthcare observed that 23% of claims across more than 500 million service lines were denied—accounting for over $62 billion in charges. With the Claims Lifecycle Artificial Intelligence capability, 35% of these denials can be identified and flagged prior to submission—representing $6.2 billion in forecasted allowed amounts and millions in potential administrative savings for the U.S. healthcare system from reduced re-work and appeals.

This initiative is backed by Change Healthcare’s team of data scientists, adoption of open source technology, and investments in the cloud. AWS provides the secure, scalable, and agile infrastructure to enable feature engineering, training of deep learning models, and delivery through an API. By using AWS Lambda, which integrates Claims Lifecycle Artificial Intelligence with network applications, and Amazon SageMaker, to decrease the development time to build, train, and deploy deep learning models, the Change Healthcare team was able to create the solution in a rapid and iterative fashion.

The application of AI across the Change Healthcare portfolio of solutions ushers in a new era of claims processing that benefits key stakeholders. For providers, it can help reduce unnecessary processing rework by assessing whether claims were completed accurately, predict expected payment, and how much will be remitted. Artificial intelligence can also help empower denial management programs by predicting claim completeness, denial probability, timing and amount paid, and flagging missing data.

For payers, Change Healthcare’s expanded AI capabilities analyze incoming claims to flag missing or incorrect diagnosis codes and help lower the administrative burden by predicting claim outcomes early, thereby reducing overhead, increasing savings by identifying errors, and optimizing workflows. AI can also help payers analyze claims data to better understand cross-industry appropriateness of care and address pre-authorization to reduce claim denials. Ultimately, this AI capability can help payers and providers ensure the accuracy of claims to make and get the right payment at the right time for the right service.

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About Change Healthcare

Change Healthcare is inspiring a better healthcare system. Working alongside our customers and partners, we leverage our software and analytics, network solutions, and technology-enabled services to enable better patient care, choice, and outcomes at scale. As a key catalyst of a value-based healthcare system, we are accelerating the journey toward improved lives and healthier communities. Learn more at changehealthcare.com.

SOURCE: Change Healthcare