Allison Gilmore, principal data scientist for Ayasdi in Menlo Park, Calif.: Claims denial reduction programs come in many shapes and sizes and vary from payer to payer. They key is to determine what they do, not what they say, as they routinely ignore their own rules. Developing the technical capacity to “reverse engineer” payer rules is the key to getting paid. Given the combinatorial complexity of the problem, it is not easy — but it will be worth the investment.
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