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Data is the lifeblood of AI, said Sundar Shenbagam, chief technology officer at Edifecs.
The challenge is to find a uniform way to collect data and store it to ensure its security. Once this is established, the data can be managed to create an AI model that automates some of the payer’s many time-consuming functions.
However, AI remains an assistant, not a substitute, for human decision-making, Shenbagam said.
To learn more about how AI can help payers, listen to Shenbagam’s conversation with Susan Morse, editor-in-chief of Health financing news.
Discussion points:
- Unstructured data, such as prescriptions and laboratory documents, covers 85% of health data exchanged today.
- Interoperability at Edifecs means that as data flows, it is collected, stored securely and uniquely connectable to an AI framework.
- AI for health plan administration can be used for member enrollment, claims, claims evaluation, and all other tasks involving tons of documents between the provider and the payer.
- The burden on health plans continues to increase
- Much of the data has errors and correcting the errors represents a huge administrative burden
- With AI, systems can become more efficient.
- For prior authorization, a large amount of data can be collected in a single query instead of requiring a human to extract the relevant data.
- Pre-authorization can take minutes instead of weeks, but it doesn’t replace humans.
- AI is an assistant feature rather than a replacement feature
Learn more about this episode:
Claim denials on the rise, complicating revenue collection, survey finds
Hospitals leverage AI to improve revenue cycle
Finance leaders balance AI investments and expected ROI
AI in healthcare requires rigorous oversight, says data scientist
AI medical assistant Suki takes over the administrative load
Email the writer: SMorse@himss.org