AI Case Study

Orlando Health pilots platform to identify patterns in denied health insurance claims to recover payments and avoid future denials

Developed by GE Healthcare, DenialsIQ uses an algorithm to search through data and find healthcare claims that were denied by insurance companies and uses pattern recognition to discover the causes. This then speeds up future resolution processes, ensuring healthcare providers are accurately paid.

Industry

Financial Services

Insurance

Project Overview

"DenialsIQ, which officially launched in July, identifies a common pattern in denials, and isolates where the problem is and its root cause. Once a company learns the pattern in their denied claims, they can then rework them in order to get paid. They can also spot and fix problems internally to avoid a repeat."

Reported Results

The vendor claims that DenialsIQ "could surface patterns in up to 80 percent of the total denied claims, and roughly one in every three of those denials are in patterns that had money that could be recovered or an action that could be taken to avoid similar denials in the future."

Technology

DenialsIQ "was built on Predix, GE’s cloud-based platform for collaborating on projects involving big data, and shaped using FastWorks — GE’s approach to building lean start-ups and prototypes, using the agile method of iterative “sprints” of work among collaborating teams... [and a] patent-pending statistical algorithm that analyzes denials."

Function

Strategy

Planning

Background

Orlando Health DenialsIQ was "developed by GE Healthcare, uses advanced analytics to help health systems find claims that were initially denied by insurance companies" making health insurance payment dispute claims less time-consuming.

Benefits

Data

Healthcare claims datasets from various institutions