Microsoft’s Rural Health Resilience Program Making Waves

Highlights:

• The losses incurred in denied claims amounts to USD 3,30,000 in the US annually
• Claim denials navigator is a free-to-use AI tool that would make claims processing hassle free for billing staff

As part of Microsoft’s Rural Health Resilience Program, the company has launched a unique AI tool, labelled the claim denials navigator, to resolve claim denials issues that are persistently faced by healthcare providers when rendering care.

The claim denials navigator is a free-to-use AI-powered tool conceptualised within Microsoft’s Rural Health AI Innovation Lab (RHAIL). The tool can be accessed from GitHub and makes claims processing easier and more streamlined for billing staff, while at the same time enabling them to improve claims processing through feedback.

Denied insurance claims happen to be one of the banes of insurance claims processing for hospitals. The cost of managing denied claims works out to around USD 3,30,000 on an annual basis. Notably, denial rates are higher for rural hospitals as compared to urban hospitals, pointing toward an existing disparity in claims dispensation.

Charting his hospital’s transition to a new electronic health record system, the CIO of Southern Coos Hospital & Health Center in Oregon, Scott McEachern, concurs that the use of the modern, AI-driven claim denials navigator app has made the process much faster and efficient.

Dr. Jim Weinstein, Senior VP at Microsoft Health, recognises the advantages of the claim denials navigator in bridging the urban-rural divide in claims dispensation and working toward the cause of delivering essential care to rural communities on par with their urban counterparts.

Microsoft will partner with the Texas Office of Rural Clinics and Hospitals (TORCH) and the Washington State Hospital Association to deploy the claim denials navigator and assess outcomes.