Semantic Health offers an AI-powered platform for concurrent medical coding and auditing, automating the secondary review of medical claims data. Its custom clinical AI and NLP algorithms interpret clinical context and evolving coding guidelines to improve accuracy and efficiency in healthcare revenue cycle management.
Funding
Funding not disclosed
FFounders
Product
Problem
Manual medical coding and auditing processes are time-consuming and prone to errors, leading to inefficiencies in healthcare revenue cycle management. This can result in suboptimal coding quality, increased claim denials, and a diversion of HIM department resources from higher-value strategic tasks.
Solution
Semantic Health provides an AI-powered platform designed for concurrent medical coding and auditing to enhance efficiency and accuracy within healthcare revenue cycle management. The platform automates the secondary review of medical claims data, leveraging custom clinical AI and Natural Language Processing (NLP) algorithms. These algorithms are trained on extensive datasets to interpret nuanced clinical context, adapt to evolving coding guidelines, and identify high-quality coding and auditing opportunities with clear evidence linkage to clinical documentation. This approach empowers Health Information Management (HIM) departments to optimize workflows, improve coding accuracy, and reduce claim denials, allowing staff to focus on more critical responsibilities.
Target Audience
The primary target audience includes acute care facilities, pediatric hospitals, and revenue cycle management outsourcing organizations seeking to improve their medical coding and auditing processes.
Features
- AI-driven platform for concurrent medical coding and auditing.
- Utilizes custom clinical AI and NLP algorithms trained on millions of records.
- Parses clinical and coded data to understand nuanced clinical context.
- Incorporates changing coding guidelines and rules for accurate suggestions.
- Provides clear evidence linkage to clinical documentation for coding and auditing opportunities.
- Automates the complete secondary review of medical claims data.
- Offers pre-billing audit coverage, achieving 100% review.
- Increases coder and auditor efficiency by an estimated 20%.
- Identifies an estimated 25% more data quality improvement opportunities.
- Differentiates from traditional Computer-Assisted Coding (CAC) tools by using true AI rather than rules-based heuristics.