Created algorithm that process claims data before sending it to the payer and flags each claim for its probability of denial from payer

Solution

• Processed huge data of claims through the intelligent ML algorithm by random forest method and classified the claim into three categories: Fully Paid, Fully Denied, Partially Denied. 
• For the category of full denial and partial denial, the appropriate CARC (Claim Adjustment Reason Codes) were predicted to allow the users to understand the reasons for denial. 
• Our algorithm can interpret the denial codes and automate the  process to correct the claims and submit to the payers