Empowered Patient Podcast

Leveraging AI and Subject Matter Expertise to Tackle Complex Healthcare Claims and Reduce Denials with Mike Esworthy EnableComp

Informações:

Synopsis

Mike Esworthy, Chief Strategy Officer at EnableComp, understands the challenges that health systems face when dealing with complex health claims such as workers' compensation, Veterans Administration, motor vehicle accidents, Medicaid, and out-of-state claims. These exception-based claims require deep subject matter expertise to identify the right payer and process the claims correctly. Using AI-driven technology, EnableComp helps hospitals manage complex claims, minimize the number of denials, optimize revenue, and allow them to focus on their core commercial claims.  Mike explains, "I think the easiest example to provide in that context, if you look at a worker's comp claim, more often than not, when a patient comes into the hospital, they don’t know who their company's workers' comp provider is, and so often they hand over the commercial insurance card. If that doesn't get caught early, the commercial insurance gets billed, it results in a denial, and the claim sits out there in the ether for 30, 45 days