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Solventum's AI-Based Revenue Integrity System Aims to Ease Medical Payment Challenges

• By John K. Waters
• 06/27/2024

Claim denials represent a significant financial strain on healthcare organizations, contributing to revenue losses and elevated administrative costs. According to a national survey of hospitals, health systems, and post-acute care providers conducted by the group purchasing and consulting organization Premier, Inc., nearly 15% of all claims submitted to private payers are denied initially, including many that were pre-approved during the prior authorization process. Hospitals and health systems spent an estimated $19.7 billion in 2022 trying to overturn denied claims, according to Premier.

A new AI-powered solution launched this week could give healthcare organizations the tool they need to not only reduce potential denials but prevent them and ensure timely and accurate payer reimbursement. The new Solventum Revenue Integrity System was developed by Solventum, the healthcare company formerly known as 3M Health Care, in collaboration with Sift Healthcare, which specializes in healthcare payments analytics and data science. It was designed to analyze clinical, coding, and payment data to identify root causes and leverage proprietary machine learning models to predict potential denials before they happen.

Throughout the patient’s journey, Garri Garrison, President of Health Information Systems at Solventum, explained in a statement, the system analyzes documents and clinical data to provide real time insights and strategic recommendations for intervention within revenue cycle workflows, making denial prevention a daily organizational practice.

"As healthcare systems grapple with increasing write-offs due to the growing denials burden, the traditional method of using claims data to reverse engineer denials is proving ineffective," Garrison said. "Our collaboration with Sift aims to shift health systems from a reactionary stance to a proactive strategy, ultimately preventing denials within the clinical workflow."

Solventum's new system focuses on enhancing clinical documentation integrity (CDI), coding, and utilization review workflows through machine learning-based interventions and "pre-bill validation." It's an integrated AI solution that "empowers" healthcare providers with near real-time insights and strategic, compliant recommendations for intervention.

"Our objective in collaborating with Solventum is to reshape how healthcare systems handle denials prevention and, more broadly, support a timely and accurate payer reimbursement outcome," said Justin Nicols, founder and CEO of Sift Healthcare, in a statement. "This solution facilitates near real time intelligence and guides data-driven decisions, truly empowering providers to optimize payment outcomes."

This new solution complements Solventum's existing suite of healthcare information system software, supporting the entire "patient journey" from the initial visit to final payment, the company says. Solventum is offering demos of the new AI-powered solution here.