The Labor Department recently sued UnitedHealth Group subsidiary UMR, alleging that it wrongfully denied claims for emergency room services and urinary drug screenings since 2015. UMR did not determine the medical necessity of the claims, denying them “based solely on diagnosis codes and not applying a prudent layperson standard," according to the complaint.
The fact that a majority of denied claims are preventable is only one aspect of a much deeper problem. Reworking claims take time, money, and resources. But here's how resource-strapped providers can leverage artificial intelligence to reimagine claims management.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
The hedge fund administrator SS&C Technologies Holdings will be the majority stakeholder, while the two payers will each hold a minority interest in the joint venture, dubbed DomaniRx. The company will develop a claims adjudication platform to support its operations.