SmarterDx Launches SmarterDenials: AI Appeals to Help Hospitals Fight Payer Denials

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Oct 28, 2024, 09:00 ET

SmarterDx's new solution gives hospitals a faster, more effective way to overturn denials and recover lost revenue.

NEW YORK, Oct. 28, 2024 /PRNewswire/ -- SmarterDx, the leader in clinical AI for revenue integrity, today announced SmarterDenials™, a powerful AI-driven appeals solution to help hospitals combat the rising tide of payer denials. Denials have surged 20% in the last five years, causing operational disruptions and revenue loss. SmarterDenials helps hospitals generate stronger clinical appeal letters by using SmarterDx's proprietary AI to quickly identify evidence and generative AI to create compelling appeal letters in minutes, empowering them to get paid more accurately and get paid faster.

The stakes are high: Today, 15% of all claims are initially denied, and hospitals spend over $20 billion annually trying to overturn them. Payers often send denials via fax or traditional mail, and after receipt, it can take hospital denials staff hours, sometimes days, to review these denials and compose clinical appeal letters. SmarterDenials streamlines this burdensome administrative process, cutting the time it typically takes to craft an appeal down to minutes, saving hospitals time and money.

Built on SmarterDx's proprietary clinical AI platform and complementary to their current SmarterPrebill solution, SmarterDenials tackles complex denials such as DRG downgrades and level of service disputes. Hospitals simply upload denied claims and SmarterDenials analyzes the patient record, identifying documentation that justifies the care provided. In minutes, SmarterDenials produces a comprehensive appeal letter backed by case-specific clinical evidence and coding references.

"This couldn't have come at a better time," said Dr. Cam Patterson, CEO of the University of Arkansas for Medical Sciences (UAMS). "At UAMS, we've seen how rising denials adversely affect our bottom line, which ultimately impacts our ability to invest more in patient care. With AI, we can create strong appeals in a fraction of the time, which is a gamechanger."

As payers tighten approval criteria, SmarterDenials empowers hospitals to fight back more efficiently, reducing administrative burden and improving outcomes.

"With SmarterDenials, we're giving hospitals the tools to fight denials quickly and effectively," said Michael Gao, CEO and co-founder of SmarterDx. "By helping hospitals better respond to the rising tide of denials and secure the reimbursement they deserve, SmarterDenials helps them focus on what they do best: serving their patients and communities."

SmarterDenials is available now as part of the SmarterDx platform, which is used by over 20 leading health systems to improve revenue integrity. Learn more at smarterdx.com.

About SmarterDx
SmarterDx builds clinical AI that empowers hospitals to achieve 100% chart accuracy for revenue integrity. Our solution helps hospitals tell the most accurate and complete story of the patient and the care that was delivered, which helps them recover millions in earned revenue and improve quality of care scores. Learn more at smarterdx.com.

CONTACT:
Emily Poe
120/80 Marketing Group
[email protected]

SOURCE SmarterDx