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AI Bill Analysis Feature

AI Bill Analysis uses Claude AI to analyze ambulance billing claims before submission to identify potential errors, fraud indicators, and billing issues. This helps reduce rejections and improve first-pass payment rates.

Note: This feature is currently in alpha testing and available to select customers only.

Overview

How AI Bill Analysis Works

The system analyzes bills for coding issues (invalid procedure/diagnosis combinations, incorrect modifiers, unbundling), billing anomalies (duplicate claims, pricing inconsistencies, fraud patterns), data quality problems (missing information, placeholder values, date/time errors), and provider/patient information issues (NPI validation, credential mismatches, eligibility concerns).

Analysis typically completes in under 5 seconds for individual bills. All PHI is handled according to HIPAA requirements with secure API protocols and maintained audit trails.

Prerequisites for using the AI Bill Analysis feature:

  • Must be in alpha testing group (contact AIM Support for more information)
  • Electronic Validations on Save & AI Bill Analysis features must be enabled in Billing Configuration Settings Setup
  • Complete data entry for a new bill and use the Save function - then users will be provided a prompt to review feedback post-analysis (see image below for example).

Accessing AI Bill Feedback

Navigate to the Warnings Encountered screen for your bill and click the AI Bill Feedback button to review AI-generated feedback in the popup window.

In order to see the screen below, Electronic Validations on Save must be enabled. When saving a bill for the first time after having completed the data entry for the bill, the Warnings Encountered screen is shown. A subsection is shown below if the AI Bill Analysis feature returned feedback. 

Understanding Validation Issues vs. AI Analysis

When you encounter warnings before transmission, you'll see two distinct types of issues:

Validation Issues are technical errors that will certainly cause rejections or denials. These are hard stops that must be corrected before submission, such as blank required fields or invalid data formats.

AI Bill Analysis identifies potential issues that may cause rejection or denial based on billing patterns, coding logic, and payer requirements. These are recommendations based on analysis of the bill data and should be reviewed, but may not always result in rejection depending on the specific payer and circumstances. AI Bill Analysis is constantly improving based on user feedback. The quality and number of suggestions provided will vary over time as more feedback is received. 

Both types of responses help improve bill quality, but validation issues require immediate correction while AI analysis provides guidance for review and decision-making.

Providing Feedback

Help improve the AI by evaluating the feedback provided for each bill.

Click the "AI Feedback" button to access the AI Analysis Feedback screen:

Feedback Screen

Feedback can be provided on the AI Bill Analysis responses in order to improve future responses, message quality, and accuracy. The columns for this screen are shown below:

  • AI Bill Analysis Message - Displays the specific issue identified, including EDI loop references and recommended corrections.
  • Helpful? - Indicate whether the feedback is relevant and valid or irrelevant and invalid for this bill. Change the slider to yes or no accordingly.
  • Comments - Provide notes on why the feedback is relevant/irrelevant or suggest improvements (maximum 500 characters).

In order to enable the Submit Feedback button, users must complete comments for each message. 

Click Submit Feedback to submit your feedback or Cancel to return without saving. Your feedback helps improve future bill analysis accuracy.

Best Practices

Review all AI feedback before transmitting claims and investigate flagged issues based on your payer knowledge and experience. Use the override capability when AI flags valid bills incorrectly, and provide feedback to help improve system accuracy.

Need Help?

Contact your AIM Support if the AI Bill Feedback button is not visible, you encounter errors during analysis, you need training on interpreting results, or you have questions about specific feedback.