Future-Proof Your Payment Integrity with Generative AI: Eight Best Practices For Getting Started

Gen AI is revolutionizing healthcare claim audits by simplifying tedious processes while significantly reducing costs. Here’s how to integrate it into your organization’s in-patient and facility audit workflows. 

By now you’ve heard the news: generative AI is dramatically reshaping payment integrity through extreme automation, improved efficiencies, increased accuracy, and significantly lower costs.  

Since Codoxo’s mission is to make healthcare more affordable and effective, we’re eager to share best practices to get you closer to adoption. 

Harnessing Generative AI for In-Patient and Facility Claims Processing

Processing complex facility claims is a tedious, time-consuming process. It can take healthcare cost containment teams as long as three weeks to manually complete a single audit. Generative AI changes the game, leveraging its sophisticated algorithms to quickly scour documentation and collect necessary data needed by clinicians to make determinations. The advanced technology automatically cross-references data from multiple sources and provides information to audit teams faster, and with greater accuracy.   

Solutions such as Codoxo’s Clinical ClaimPilot make it possible to complete audits in less than 24 hours, moving teams from an average of two to three audits per day to 20 or more. With audit efforts streamlined by 84%, there’s no longer a need to spend days pouring over documents that can span thousands of pages. Clinicians and their teams can focus on higher value work instead of weeding through mounds of documentation. Clinical ClaimPilot’s generative AI also allows healthcare payers to review claims of all sizes, removing restrictions for reviewing only claims above a certain dollar threshold.

The following are best practices your organization can use to help you achieve these same results.

Eight Best Practices To Move Toward Zero-Touch Payment Integrity

To get you closer to reaping benefits from generative AI’s extreme efficiencies and cost savings, here’s our list of eight best practices to help get you started toward a zero-touch approach for automating in-patient and facility claim audits:

#1. Cultivate a culture of learning. Make educating your cost containment team a priority. You can start by establishing subject matter experts (SMEs) across your organization. This might mean appointing executives dedicated to AI or recruiting specialists to educate your team on best practices. Collaborate with industry leaders who understand both your niche and AI – their insights will prove invaluable. 

#2. Determine the best place to start. Look for small use cases where pain points exist and Gen AI can be leveraged to create improvements. Talk to employees, customers and other stakeholders about the daily challenges they face. Consider if Gen AI is a viable solution to help.

#3. Develop your implementation strategy. Decide if you’d prefer to build your own AI solutions or use online capabilities. If you opt to take the online route, you’ll find there are many services that offer algorithms, APIs and development tools specifically designed to deploy machine learning models. To ensure you select the best solution for your needs, ask yourself these questions:

• Who are the target users? 
• What special needs, inequities, or other factors must be considered?
• What user experience do we want to achieve?
• Where are our data sources? 

#4. Take a phased approach. Start small – develop an initial pilot to test hypotheses, find potential barriers, and optimize the model. Once you get through an initial implementation, share your insights with stakeholders and gather user feedback to make iterative improvements. Remember, how you adopt and use Gen AI should be tailored to your organization’s unique needs.

#5. Keep refining your technique. To maximize Gen AI and its transformative impact, you must update your models regularly. It’s not a once-and-done effort. As powerful as the technology is, it’s only as good as the quality of the feedback and training it receives. 

#6. Understand that Gen AI has limitations. While Gen AI is game-changing for the healthcare industry and payment integrity, it does have limitations. It’s critical to understand the technology’s potential while also keeping expectations realistic. 

#7. It’s not one size fits all. Every healthcare organization is at a different level of AI maturity and must understand their specific goals, requirements and challenges when implementing the technology. A knowledgeable, experienced partner like Codoxo can guide you through that process. 

#8. Choose the best partner. AI is a rapidly growing field, with the companies behind the technology always developing new capabilities. To ensure your AI initiative is successful, work with a company with proven experience in both Gen AI and healthcare and data security, because of course, security reigns paramount for healthcare organizations. Ask yourself these questions before selecting your Gen AI partner: 

• What is our use case? 
• What data do we need to train it? 
• How important is explainability? 
• What business rules must be applied? 

Choosing who to work with is one of the most important decisions you’ll make. You need a partner who can guide you through the process, with solutions that can meet you no matter where you are on your AI journey. 

Now is the Time To Get Started 

At Codoxo, our sole focus is future-proofing payment integrity. This means we truly understand your cost containment pain points, and can develop a holistic AI plan that includes generative AI solutions to address them. 

But here’s the key: to take advantage of Gen AI in the future, get started now with your exploration. While Gen AI is more accessible than ever, adoption takes time. Automating in-patient and facility claim audits is just one of many possible applications of generative AI – and a monumental step toward a seismic shift left in your healthcare cost containment strategy.  

The pace of AI in healthcare has gone supersonic. To help you navigate the rapid evolution of generative AI and its transformative impact on payment integrity, consider Codoxo as a trusted partner to safely and powerfully accelerate your healthcare AI journey. Because together, we can innovate, integrate, and make a lasting impact on the future of healthcare.