What You Should Know:
– Hospitals across the country are facing an ever-increasing onslaught of claims denials from insurance companies, with denials up 20.2% in 2023, according to the American Hospital Association. These denials – triggered by AI and often error-prone – cost hospitals $20 billion a year in administrative bloat and reduce patients’ access to quality care.
– To help hospitals fight back, Cofactor AI today introduced a new first-of-its-kind AI-powered platform to easily, quickly, and successfully appeal denials. Cofactor AI also announced a $4 million seed funding round led by Drive Capital.
Cofactor AI: Revolutionizing the Denial Appeal Process for Healthcare Efficiency
Cofactor AI’s Cofactor Denial Suite redefines the claims denial appeal process by integrating seamlessly with electronic health record (EHR) systems and clearinghouses. Leveraging a proprietary medical-native foundation model, the platform automates the identification of contextual information essential for crafting successful appeals.
Key Features and Functionality
- Comprehensive Analysis: Cofactor AI reviews clinical evidence, coding and standard-of-care guidelines, payer policies, and facility contracts to identify discrepancies between claims and documentation.
- Automation: By replacing traditional labor-intensive processes—such as phone calls, emails, and manual reviews—the platform streamlines appeals with unprecedented speed and accuracy.
Challenges of the Traditional Appeal Process
Hospitals spend an average of $181 per claim appeal, with many incorrect denials going unchallenged due to the significant time and effort required. Conventional processes involve:
- Laborious document searches and contract reviews.
- Endless forms, faxes, and administrative meetings.
- Extended timelines for appeals resolution.
Benefits of Cofactor AI
The platform delivers transformative benefits for healthcare institutions:
- Reduced Administrative Burden: A single individual can manage all claims denials in mere minutes, significantly increasing operational efficiency.
- Protection for Patients: By reducing denials, hospitals minimize the risk of transferring financial burdens to patients, safeguarding them from unexpected expenses.
- Increased Access to Care: Lower denial rates help stabilize hospital finances, allowing institutions to remain operational and serve their communities effectively.
Driving Financial and Operational Sustainability
Cofactor Denial Suite empowers healthcare providers to overcome the systemic challenges of claims denials. By enabling faster, cost-effective appeals, the platform enhances financial health, protects patient care access, and supports the broader mission of sustainable healthcare delivery.
Margaret Schuler, a revenue cycle management executive and industry expert, is an advisor to Cofactor AI. “More than ever there is a need for innovation and automation in the RCM space. Denials continue to plague the healthcare industry, compounding the already complicated payment model. Cofactor AI leaned into curing this plague with their new Cofactor Denial Suite, proving to be effective at removing manual intervention, increasing overturn rates, and securing the appropriate reimbursement for services delivered.”
