en.Wedoany.com Reported - Artificial intelligence-driven healthcare payer intelligence company Anomaly Insights has launched a new tool, Manage, designed to provide healthcare system executives with data evidence for negotiations with insurance companies. CEO Mike Desjadon told Fierce Healthcare that the U.S. healthcare industry has an "adversarial payment system," with a "fundamental data asymmetry" between insurers and healthcare providers, which allows insurers to essentially exhaust healthcare systems through claim denials and various data-driven tactics.
The Manage solution reviews all claims records for every payer in a healthcare system's contracts, identifying patterns and analyzing complex data from contracts to claims. Through this tool, providers can see when each payer denies claims that should have been paid or downgrades services to lower reimbursement codes. Desjadon stated that Manage's overall goal is to provide a data-driven mechanism that can repeatedly, reliably, and with minimal human effort prompt insurers to proactively change their behavior.
Founded in 2020, Anomaly uses machine learning to identify anomalies in medical billing, preventing overpayments and billing errors. The company's platform also includes detection, prediction, and recovery solutions. Manage is the latest product on the platform.
Chief Product Officer Dan Unger said that feedback from systems using the solution has been "very positive," and Anomaly built the tool collaboratively with customers. He noted: "We have tangible success stories where we've helped payers stop certain behaviors and change their practices, resulting in millions of dollars in verified outcomes. That's what excites me—our customers are seeing change." Currently, four customers are using the Manage solution, with several others in discussions. Desjadon said the solution may be available to all customers by the end of the year.
Desjadon stated that Anomaly works with "over 20 organizations," covering approximately "tens of millions" of patients. He said the company started with the largest healthcare systems because their issues are most pronounced. In an early deployment of Manage at a major U.S. healthcare system, two payer patterns were identified, with an annual financial impact exceeding $110 million. After presenting the data to the payers, a settlement was reached, and the underlying issues were resolved. Unger said: "Our goal is to balance the playing field, filter out the noise, and move toward more frictionless transactions."
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