The RCxRules Blog

Use Cases for AI in Healthcare

What is Artificial Intelligence (AI) in Healthcare?

AI in Healthcare refers to the use of machines (i.e. automation, algorithms, machine learning, and other cognitive technologies) to interact with healthcare data, often as a replacement for, or addition to, human brain power.

RCxRules offers AI-driven solutions that streamline your revenue cycle and risk adjustment workflows. Our Revenue Cycle Engine automatically corrects administrative billing and coding errors that would otherwise require human intervention. Below are some other promising use cases for AI in healthcare.

AI for Autonomous Coding

AI can be used to analyze patient data, like encounter and lab data as well as patient history, visit notes, prescription lists, and more. By leveraging Natural Language Processing (NLP), AI can identify key terms and phrases and use them to automate clinical coding processes.

AI for Claim Status Inquiry

Claims that don’t receive a payer response create a lag in payment and typically take time to chase down and follow up on. Instead of tasking employees to follow up on claim status, medical groups now have the option of using AI instead.

AI can complete a comprehensive follow-up to payer responses by taking account information from an EHR or patient accounting system and checking the payer portal. It can even take the next steps necessary for a denial, rebill, or appeal.

AI for Prior Authorization

Prior authorization requirements have historically required extensive back and forth between the provider and the health plan. These phone calls and emails are time consuming, often frustrating work.

AI can be applied to these prior authorization approvals to expedite the process. By moving the process to the point of care and leveraging AI to perform clinical reviews, AI can significantly reduce the administrative burden.


To learn more about improving revenue cycle integrity with AI, set up a 15-minute meeting today.


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