We are excited to introduce a powerful new feature: AI-Powered Denial Reason Explanations. This feature leverages advanced AI to provide concise and clear explanations for insurance claim denials directly on the Remit AI Dashboard.
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Key Benefits:
- Enhanced Clarity: Get precise and easy-to-understand reasons for claim denials in just 12 words or less.
- Detailed Insights: Along with the brief explanation, receive a slightly more detailed reasoning, including any important details like required documents or time frames, ensuring you have all the information needed to take action.
- Simplified Workflow: With the denial reasons clearly outlined, streamline your workflow and reduce the time spent on resolving denials.
How It Works:
- Summarized Reason: The AI analyzes the adjustment codes and notes to provide a summarized reason for the denial, ensuring that even complex denials are easily understood.
- Detailed Explanation: In addition to the short summary, the AI offers a slightly longer explanation in a single, concise sentence, capturing all critical details.
Here is an Example:
Original Denial:
- Procedure Code: D4341
- Procedure Code Description: Root planning and scaling.
- Adjustment Codes and Notes:
- The X-rays submitted were of poor diagnostic quality and/or were not sufficient to complete a review of this service. Please provide current pre-operative X-rays related to the treatment, dated, marked right and left, and of good diagnostic quality depicting appropriate structure. When we receive this information, our consulting dentist will review this charge. Please send us this information within 45 days from the date you receive this statement. We will make our benefit determination either (1) within 15 days after we receive the information we need or (2) within 45 days from the date you receive this statement, whichever is earlier. If we do not receive the information we need, this charge will be denied. The effective date of the denial will be the 46th day after the date you receive this statement. The basis for the denial will be that we do not have the information we need to consider this charge. You will have a right to appeal that denial at that time. For claims submitted from North Carolina, you have 90 days to respond to the request for information. If you fail to respond in 90 days, and receive a denial notice, you may submit the requested information within one year from the date the claim was denied and your claim will be reopened. This does not apply to Federal Plans. For claims submitted from Texas, we will make our benefit determination either (1) within 15 days after we receive the information we need, or (2) within other applicable statutory time periods that apply to you. For applicable provider claims submitted from Texas, your claim will remain open until you provide the requested information. This does not apply to Federal Plans.
- This service is being considered at the benefit level for this plan’s Dental Medical Integration (DMI) Program.
AI-Powered Denial Reason Explanation: