Analyzing Health Policy with GenAI for Optimized Claims Edits

Policies and guidelines hold crucial information for accurate and impactful claims edits, but constantly tracking these updates can drain a health plan’s time and resources. The manual process of finding the right details risks missed insights and inefficiencies, which can affect overall payment integrity and prevent healthcare fraud, waste and abuse.

Watch the video below to see how Shift's Generative AI revolutionizes this process by identifying and analyzing policy, guidelines or other documents to find that critical detail quickly and accurately. With Shift AI, plans can easily identify relevant policy or guideline documents, then extract relevant coding and billing information to generate custom secondary edits with precision, ensuring optimized payment integrity and increased savings.

Analyzing Health Policy with GenAI for Optimized Claims Edits

Policy, guidelines, and post-pay audits contain critical detail to strengthen prepayment interventions and edits. But tracking updates and parsing through the documents requires teams to go deep into the details. This analysis takes extensive time and resources, and can result in missed insights, missed details, and improper payments.

Shift AI Feature Highlight: analyzing documents for claim edit generation

• Shift stays on top of policy, guidance, audits, and other useful documentation, automatically finding and analyzing new documents as they are published.
• Shift's GenAI scans the docs to identify relevant codes and guidelines, with pinpoint accuracy in a fraction of the time
• Shift generates custom, enhanced edits, and deploys them in the Shift platform for optimized edits, increased savings, and stronger payment integrity

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Want a deeper dive? Hear more from US Healthcare Lead Data Scientist, Juandiego Marquez on how policy and guideline documents are selected, analyzed and incorporated into an enhanced claims editing and prepay strategy in this webinar snippet.