Most appeals systems are not built for the Payment Integrity operations. They are built for managing general appeals and grievances from providers. Leveraging the Payers generic appeals application hampers the PI team and makes the resolution process cumbersome. With a generic appeals application, the PI team will need to look up information in multiple systems before they can resolve a provider dispute.
ClaimShark appeals module is purpose built for Payment Integrity. Having access to all your claim, audit and provider information helps streamline & accelerate the appeal management process. Machine Learning can help understand and predict provider behavior to help reduce appeals and abrasion