Change Healthcare Launches First AI-Powered Claims Management Platform Ahead of IPO

From February 11 to 15, the 2019 HIMSS Global Conference & Exhibition (hereinafter referred to as HIMSS19) was held in Orlando, Florida, USA. As one of the most influential large-scale exhibitions in the global healthcare information technology industry, it attracted 45,000 attendees, including healthcare IT professionals, clinicians, healthcare administrators, government policymakers, and corporate representatives from more than 90 countries worldwide.

During the HIMSS19 conference, Change Healthcare, a prominent U.S. healthcare IT company, announced the launch of its AI-powered claims management platform. This product integrates AI capabilities with the company’s intelligent healthcare network and financial solutions to help healthcare providers and payers optimize the entire claims processing workflow.

Change Healthcare’s claims management platform AI services have been trained on more than 500 million service lines, including over 205 million unique claim items, representing $268 billion in costs. This AI service leverages Change Healthcare’s Intelligent Healthcare Network data, sourced from more than 2,200 payers, 5,500 hospitals or health systems, and 900,000 physicians. Solutions and services within Change Healthcare’s portfolio are utilizing AI to help customers improve payment accuracy, reduce the likelihood of denials, enhance payment predictability, and lower administrative overhead.

“Our strategy is to introduce AI technology into the entire healthcare financial and administrative ecosystem, with the claims lifecycle management platform serving as the starting point for this strategy,” said Dr. Nick Giannasi, Chief AI Officer at Change Healthcare. “We are leveraging AI to reshape the cost/quality curve in healthcare. By applying AI to our Intelligent Healthcare Network data, combined with our collaborations with payers and providers, we will deliver new health IT solutions that help customers address the financial pressures of medical costs in unprecedented ways. It is expected that the application of AI technology will transform the entire claims lifecycle process.”

Change Healthcare’s first three clients (applications) have seen performance improvements by leveraging the AI-powered claims management platform; they are Assurance Reimbursement Management™, Revenue Performance Advisor, and Medical Network Solutions. The AI embedded within these applications helps clients predict the likelihood of claim denials, optimize the claims submission process, and provide actionable recommendations, enabling healthcare providers to better reduce the probability of denial before submitting claims. Additionally, customers using Change Healthcare’s Intelligent Healthcare Network will be able to access their selected AI capabilities through the Change Healthcare API Marketplace.

Change Healthcare found that in 2018, 23% of claim line items were denied across more than 500 million service lines, involving amounts exceeding $62 billion. With AI-powered claims lifecycle management capabilities, 35% of these denied claims could be identified and flagged prior to submission. This means an additional $6.2 billion in claim reimbursements could be secured, while reducing rework and appeals for claims staff, thereby saving the U.S. healthcare system millions of dollars in administrative costs.

The AI-powered Claims Cycle Management Platform was developed by Change Healthcare’s team of data scientists using cloud computing and open-source technologies. AWS provides a secure, scalable, and flexible infrastructure to support feature engineering, deep learning model training, and API delivery. By leveraging AWS Lambda—which integrates claims cycle AI with web applications—and Amazon SageMaker, the Change Healthcare team reduced the development time required for building, training, and deploying deep learning models, enabling them to create solutions through rapid iteration.

The application of AI in Change Healthcare’s portfolio of products has ushered in a new era of claims processing, delivering benefits to key stakeholders across the ecosystem. For healthcare providers, it reduces unnecessary rework by evaluating whether claims are accurately completed and predicting expected payments. By forecasting claim completeness, denial probability, payment timing, and payment amounts, as well as flagging missing data, AI also enhances the capabilities of “denial management programs” within claims systems.

For payers, the AI capabilities of Change Healthcare’s claims management platform can analyze claim line items to flag missing or incorrect diagnosis codes. By predicting claim outcomes early, it optimizes workflows and reduces administrative burden, thereby lowering overhead and eliminating unnecessary costs. AI also helps payers analyze claims data to better understand cross-industry care appropriateness and manage prior authorizations, reducing the likelihood of claim denials. Ultimately, Change Healthcare’s AI-driven claims management solutions help payers and healthcare providers ensure claim accuracy and facilitate appropriate payment for reasonable services at the right time.

(Compiled by Cheng Xiaoqin)