What’s The Scoop On AI & Claims Denials?

Early adoption comes with snags. I learned of such snags with AI on health plan claims management through a recent ProPublica report—How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them—and the resulting lawsuits filed by consumers and provider organizations (see;UnitedHealthcare Accused Of AI Use To Wrongfully Deny Claims and Lawsuit Alleges Humana Used AI To Deny Medically Necessary Claims).;The crux of the matter is the high-level Medicare Advantage claim denials that started with the installation of AI decision algorithms—over 300,000 claims within a 2-month period at . . .