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.
The future looks bright for the integrated specialty pharmacy model – for health systems, providers, and most importantly, for patients.
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.