AI-Driven Review to Enhance Healthcare Billing Integrity

At a glance

Facing increasing claim denials and billing inaccuracies, the client leveraged LLM-powered AI to review clinical documentation and streamline claims processing. This helped reduce improper submissions, denial rates, and compliance risks while improving operational fairness.

35%

reduction in improper claim submissions

30%

fewer denials across payers and providers

50%

less manual effort in claim appeals

About the client

The client is a world-leading cancer treatment and research institution, consistently ranked among the top cancer hospitals globally. Each year, it cares for over 400,000 patients and operates one of the largest cancer research programs in the U.S.

Challenges

The client faces tens of billions in annual billing losses due to high volumes of claim denials caused by missing or inconsistent documentation, compounded by the rising complexity of compliance requirements.

Solutions

LLM-powered review of clinical records, claims, and notes to identify inconsistencies
Automated extraction of key data and code recommendations
Claim-by-claim assessment against payer behavior and coverage patterns
Continuous claim scanning for under-documentation, over-utilization, and compliance gaps

Results and benefits

The platform significantly improved billing integrity with reduced denial rates and accelerated appeal cycles. Clients gained real-time visibility into risk, enabling proactive compliance and fairer, more efficient financial operations.