Hartford HealthCare, one of the state’s largest healthcare systems, has formed a partnership with Milwaukee-based Sift Healthcare intended to reduce insurance claim denials and improve reimbursement accuracy by applying artificial intelligence earlier in the care process.
Terms of the deal, which was announced Wednesday, were not disclosed.
Sift Healthcare develops analytics tools to help health systems deal with complicated insurance payment rules and improve how they manage billing and payments.
Sift’s collaboration with Hartford HealthCare will combine clinical, coding, authorization and payment data to find issues that can lead to denied or underpaid claims. The effort shifts the focus from fixing denied claims after the fact to preventing problems earlier, such as getting approvals before care, deciding the right level of care and clearly writing down patient information — steps that affect payment before a claim is sent.
Cynthia Pugliese, Hartford HealthCare’s senior vice president of revenue cycle services, said reimbursement challenges increasingly begin well before claims submission, making earlier intervention critical.
Dr. Barry Stein, Hartford HealthCare’s chief innovation officer and leader of its Center for AI Innovation in Healthcare, said the collaboration will allow the health system to apply advanced AI tools to strengthen documentation, authorization and reimbursement processes.
Sift Founder and CEO Justin Nicols said insurers are using increasingly sophisticated analytics to make reimbursement decisions, requiring health systems to respond with comparable tools.
Hartford HealthCare employs about 48,000 people and operates more than 500 locations across Connecticut, including seven hospitals, as well as physician groups, behavioral health services and outpatient facilities. The system reports serving nearly 28,000 people daily.
