At Prochant, we are redefining revenue cycle management (RCM) by integrating cutting-edge AI into our services. Through strategic partnerships with top-tier AI companies, we bring best-in-class AI solutions to our clients, enabling them to streamline operations, maximize revenue capture and increase efficiency. By customizing AI models with client-specific data, we ensure that providers’ unique needs are met, transforming the RCM process and delivering optimal results.
AI-Powered Innovations Driving Revenue Cycle Optimization
Denial Payment Probability
One of the most pressing challenges in RCM is managing denials efficiently. Our AI-driven Denial Payment Probability model assigns a probability score to denials, predicting the likelihood of payment. This feature is seamlessly integrated into our work allocation process, allowing our expert staff to prioritize denials with the highest likelihood of payment first.
Key Benefits:
- Increases revenue capture and speeds up collection times.
- Improves efficiency by enabling smarter work allocation.
- Optimizes staff workload by focusing efforts where they yield the highest returns.
Virtual AI Coach
To further enhance the denial resolution process, our Virtual AI Coach utilizes an AI-powered decision tree to guide our agents through best-practice workflows. This tool provides real-time denial checklist scenarios tailored to specific payors and denial reasons, ensuring a streamlined and standardized approach to A/R resolution.
Key Benefits:
- Accelerates denial resolution with clear, actionable guidance.
- Ensures consistent case handling, leading to improved overturn rates.
- Empowers lower-skilled staff to manage more complex claims effectively.
The Virtual AI Coach makes it easy for our agents to access the insights they need, reducing resolution time and increasing overall accuracy in claim management.
AI Billing Review
A proactive approach to preventing denials begins at the billing stage. Our AI Billing Review tool systematically reviews bills before submission, ensuring that all necessary components are present and accurate. The system checks for:
- Structural elements (CMN, Delivery Ticket, Diagnosis Codes)
- Clinical values (ensuring documents meet medical necessity requirements)
- Quantity limits (using historical data to verify appropriateness)
Key Benefits:
- Enhances clean claim rates, reducing the risk of denials.
- Increases efficiency by minimizing manual document review.
- Delivers 100% claim coverage, eliminating the limitations of sample-based audits.
AI Calling
One of the biggest challenges in RCM is securing timely and accurate claim resolutions. Our AI Calling feature automates calls to insurance companies, gathering real-time claim updates and denial information on behalf of Prochant. This intelligent system ensures a seamless transfer of verified details directly into Pulse, enhancing workflow efficiency and decision-making.
Key Benefits:
- Reduces staff workload by handling claim status and denial resolution calls automatically.
- Captures precise details, minimizing human error and missed information.
- Overcomes time constraints like long hold times and call drop-offs, reducing delays and inefficiencies.
- Allows staff to focus on more strategic activities, empowering them to focus on higher-value tasks.
What’s Next?
Prochant is committed to continuously enhancing our AI capabilities, with more innovations on the horizon. Our AI strategy is designed to scale beyond our organization, empowering home-based care providers with intelligent, automated tools that simplify RCM, improve financial outcomes and drive operational excellence.
Stay tuned for upcoming AI enhancements that will further revolutionize revenue cycle management.
Ready to unlock the power of AI in your RCM process? Contact Prochant today to learn how our AI-driven solutions can help your organization maximize efficiency and revenue potential.
