HIMSSCast: AI as assistant, not replacement
AI is only as good as the quality of the data, says Sundar Shenbagam, chief technology officer at Edifecs.
Photo: Tetra/Getty Images
Data is the lifeblood of AI, said Sundar Shenbagam, chief technology officer at Edifecs.
The challenge is having a uniform way to collect the data and maintain it to make sure it remains secure. Once that's established, data can be managed to come up with an AI model that automates some of the numerous time-consuming payer functions.
However, AI remains an assistant, not a replacement, to human decision-making, Shenbagam said.
For more on how AI can help payers, listen to Shenbagam's conversation with Susan Morse, executive editor of Healthcare Finance News.
Talking Points:
- Unstructured data such as prescriptions and lab documents, covers 85% of the healthcare data being exchanged today
- Interoperability at Edifecs means that when data flows, it is collected, securely stored and uniquely pluggable into an AI framework
- AI for health plan administration can be used for member enrollment, claims, claims adjudication and all other tasks that involve tons of documents between provider and payer
- The burden on health plans is ever increasing
- Much of data has errors and error correction is a huge administrative burden
- Using AI, systems can become more efficient.
- For prior authorization, a large amount of data can be collected into one request instead of having a human extracting the relevant data
- Prior authorization can flow in minutes instead of weeks, but it doesn't replace humans.
- AI is assistant functionality rather than replacement functionality
More About this Episode:
Claims denials on the rise, complicating revenue collection, survey finds
Hospitals are leveraging AI to improve revenue cycle
Finance leaders balance AI investment to expected ROI
Healthcare AI requires rigorous monitoring, says data scientist
AI physician assistant Suki takes over the administrative burden
Email the writer: SMorse@himss.org
