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Ai Use In Claims Processing And Utilization Review, Robert Rosenthal Dds Apr 2021

Ai Use In Claims Processing And Utilization Review, Robert Rosenthal Dds

The Journal of the Michigan Dental Association

This paper investigates the use of artificial intelligence (AI) in claims processing and utilization review in the dental industry. This article aims to explore the potential benefits of AI in this area, such as increased efficiency, accuracy, and fraud detection. The paper begins by providing an overview of the current state of claims processing and utilization review in the dental industry. It then discusses the potential applications of AI in this area, such as automated claims adjudication, predictive analytics, and image recognition. The paper then presents a case study of P&R Dental Strategies, LLC, a leading business intelligence solutions provider …


A Prescription For Charity Care: How National Medical Debt Ills Can Be Alleviated By Integrating State Financial Assistance Policies Into The Nonprofit Tax Exemption, Margarita Kutsin Feb 2019

A Prescription For Charity Care: How National Medical Debt Ills Can Be Alleviated By Integrating State Financial Assistance Policies Into The Nonprofit Tax Exemption, Margarita Kutsin

Seattle University Law Review

Despite having the most expensive healthcare system in the world, the United States has been consistently ranked as having the worst system in terms of equity, efficiency, and healthcare outcomes among industrialized nations. The effects of these systemic issues are grounded in the patient experience as nearly forty-four percent of individuals have forgone recommended treatments and thirty-two percent have reported that they were unable to afford a prescription due to the high cost, according to a study conducted in 2018. Health is sacred, and financial circumstances should not determine the difference between treatment and illness, or life and death. “Financial …


Regulating Black-Box Medicine, W. Nicholson Price Ii Dec 2017

Regulating Black-Box Medicine, W. Nicholson Price Ii

Michigan Law Review

Data drive modern medicine. And our tools to analyze those data are growing ever more powerful. As health data are collected in greater and greater amounts, sophisticated algorithms based on those data can drive medical innovation, improve the process of care, and increase efficiency. Those algorithms, however, vary widely in quality. Some are accurate and powerful, while others may be riddled with errors or based on faulty science. When an opaque algorithm recommends an insulin dose to a diabetic patient, how do we know that dose is correct? Patients, providers, and insurers face substantial difficulties in identifying high-quality algorithms; they …


Comparative Effectiveness Research As Choice Architecture: The Behavioral Law And Economics Solution To The Health Care Cost Crisis, Russell Korobkin Feb 2014

Comparative Effectiveness Research As Choice Architecture: The Behavioral Law And Economics Solution To The Health Care Cost Crisis, Russell Korobkin

Michigan Law Review

With the Patient Protection and Affordable Care Act (“ACA”) set to dramatically increase access to medical care, the problem of rising costs will move center stage in health law and policy discussions. “Consumer directed health care” proposals, which provide patients with financial incentives to equate marginal costs and benefits of care at the point of treatment, demand more decisionmaking ability from consumers than is plausible due to bounded rationality. Proposals that seek to change the incentives of health care providers threaten to create conflicts of interest between doctors and patients. New approaches are desperately needed. This Article proposes a government-facilitated …