What are the tangible ways AI can make this process easier? The most obvious improvement is in the claims scrubbing process, something historically managed by clearinghouses—a tool that allows providers to easily send batches of electronic claims to different insurance payers at once. Clearinghouses reject malformed claims before they get sent to payers based on certain universal rules, which include formatting issues, incorrect use/combinations of codes or conflicting insurance information. Using payer policies as ground truth and learning from every denial, AI tools can create a comprehensive rule engine for each individual payer so that no claim is denied for the same reason as another, taking the onus off the biller to read and remember policies, which are often unnecessarily complex and constantly changing. Then, with access to the EMR, AI could automatically resubmit a corrected claim, or flag the issue if information is missing. Eventually, a billing team would no longer be necessary—the rules engine would allow the AI to build the claim correctly on its own.
