Webinar: Driving Payment Integrity with AI-Powered Precision

The webinar highlighted the role of artificial intelligence (AI) in improving payment integrity for health plans. Led by Jared Lorinsky, Chief Strategy Officer, and Carl Anderson, Director of Product Marketing, the discussion focused on how AI can enhance payment accuracy and improve efficiency in claims processes.

Key takeaways

• AI as a Priority: Over 80% of health plan leaders rank AI as a high or medium priority for improving payment accuracy.
• Supporting, Not Replacing: AI simplifies and optimizes processes without eliminating the need for human expertise. It complements tasks, making them more efficient.
• Incremental Implementation: Practical use cases, like summarizing medical records for faster reviews, show how AI can be adopted step by step to bring meaningful improvements.

Enhanced DRG Solution and AI Integration

HealthEdge Source has partnered with Gynisus to bring AI-powered Diagnosis-Related Group (DRG) edits to its platform. The initial implementations focus on Excludes 1 and Code First rules to ensure compliance and improve claim accuracy. Best of all, these tools integrate directly into the HealthEdge Source platform, with no extra technical setup required.

What's in the roadmap?

Future enhancements will expand AI capabilities to handle readmissions, clinical validation, procedure appropriateness, and fraud detection, offering comprehensive payment integrity solutions. Health plans gain optimized performance with a robust suite of AI tools that ensure compliance, accuracy, and efficiency.

For additional resources, check out our work around AI and future enhancements to our payment integrity solution.