Using AI to Solve Healthcare’s Most Costly Problems

Among the biggest contributors to the high cost of healthcare in the U.S. are the inherent complexities and misaligned financial interests of payers, providers, and patients. Change Healthcare is using Artificial Intelligence (AI) and machine learning (ML) to identify inefficiencies and drive them out of administrative processes in the healthcare system and, as a result, help reduce costs and improve outcomes for payers, providers, and patients.

Our Claims Lifecycle AI
capability can identify

6.8 billion

in forecasted allowed
amounts pre-submission*

Our Mission: Use AI to Bend the Healthcare Cost/Quality Curve

Healthcare struggles with a massive administrative burden that costs hundreds of billions of dollars annually.2 In fact, many of these unnecessary administrative costs are associated with fraud, waste, and abuse; no- or low-value-added work; and lack of collaboration between stakeholders. Machine learning and AI have the power to change this––helping to reduce costly, time-consuming manual processes and truly changing the cost-quality curve in healthcare.

By embedding AI into our financial, clinical, and engagement solutions, we are steadily eliminating inefficiencies from our customers' workflows and removing barriers to collaboration. Our practical approach to AI focuses on making healthcare more efficient and cost-effective. Today, solutions and services across our portfolio use AI to help customers improve payment accuracy, reduce denials, enhance payment forecasting, and slash administrative overhead.

Our AI Applications Help

Improve claims lifecycle management

The application of AI across our Intelligent Healthcare NetworkTM and embedded into our claims management workflow helps hospitals and health plans optimize the entire claims processing lifecycle, mitigate denials before claims submission and realize new efficiencies. This is all made possible with the Denial Propensity Scoring feature of our Assurance Reimbursement Management Solution.

Discover our AI-powered reimbursement management solution

Prevent claim denials before they happen

When a claim is denied it is returned to the system, goes through the process again and leads to delayed or inaccurate payments and consumer frustration. Our AI can identify potential issues and flag a claim before it is denied. See how Revenue Performance Advisor helps Physician Practices and other Providers with denials management.

Discover our smart revenue cycle management software

Identify and enroll dual eligibles

There is a whole population of consumers who are eligible for both Medicaid and Medicare and don’t even know it. Our AI can help health plans identify, engage, and enroll those dual-eligible individuals.

Discover our modernized dual enrollment solution

Identify missing charges and capture revenue

Our AI-infused charge capture solution helps Hospitals and Health Plans identify potentially missing charges for services performed before claims are submitted. The result: more complete capture of services rendered without additional time and effort by hospital revenue integrity teams. Proactively create a more complete claim to increase and accelerate revenue with Charge Capture Advisor.

Discover our AI-infused charge capture software

Making a Difference With Artificial Intelligence

  • 500M

    service lines, representing $268B, used to train Claims Lifecycle AI model*

  • 35%

    of denials can be identified and flagged pre-submission*

  • 7.2Mx

    faster speed of auto-coding vs. manual coding EMS claims*


Press Releases

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Hear From Our Experts

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2Health Affairs and the Robert Wood Johnson Foundation. "Health Policy Brief: Reducing Waste in Health Care," Health Affairs, December 13, 2012.

*Statistics are Internal Change Healthcare Metrics