CHICAGO, Nov. 25, 2024 (GLOBE NEWSWIRE) -- Hospitals across the country are facing an ever-increasing onslaught of claims denials from insurance companies, with denials up 20.2% in 2023, according to the American Hospital Association. These denials – triggered by AI and often error-prone – cost hospitals $20 billion a year in administrative bloat and reduce patients’ access to quality care.
To help hospitals fight back, Cofactor AI today introduced a new first-of-its-kind AI-powered platform to easily, quickly, and successfully appeal denials. Cofactor AI also announced a $4 million seed funding round led by Drive Capital.
Cofactor AI’s platform, Cofactor Denial Suite, integrates with EHR systems and clearinghouses and instantly finds the exact contextual information required to generate winning appeals. Using its proprietary medical-native foundation model, Cofactor AI reviews clinical evidence, coding guidelines, standard of care guidelines, and peer-reviewed studies, and identifies discrepancies between claims, medical documentation, payer policies, and facility contracts.
“Fighting claims denials is an overwhelming challenge for hospitals,” said Adi Tantravahi, Cofactor AI’s co-founder and CEO. “Cofactor AI puts powerful, AI-driven tools directly into the hands of providers to ensure they are compensated fairly for the care they deliver to patients. We are leveling the playing field in the AI arms race between payers and providers.”
The traditional denial appeal process involves phone calls, emails, meetings, faxes, document searches, contract reviews, and endless forms, and can take hours of effort per appeal. For hospitals, it costs $181 on average to appeal a single claim. Further, many incorrect denials go unappealed by hospitals due the time and energy required to appeal them.
Margaret Schuler, a revenue cycle management executive and industry expert, is an advisor to Cofactor AI. “More than ever there is a need for innovation and automation in the RCM space. Denials continue to plague the healthcare industry, compounding the already complicated payment model. Cofactor AI leaned into curing this plague with their new Cofactor Denial Suite, proving to be effective at removing manual intervention, increasing overturn rates, and securing the appropriate reimbursement for services delivered.”
Cofactor AI’s benefits are clear:
- Reduced Administrative Load – A single person can review and appeal all claims denials in just minutes a day.
- Protect Patients from Financial Surprises – When payers deny claims, hospitals may be forced to go to the patient for compensation. With fewer denials, this risk decreases.
- Increased Access to Care – Rampant denials have led some hospitals to go out of business or to operate on the margins of financial health, limiting their ability to effectively serve their communities.
Alex Forbis, associate director of denials for Banner Health, has evaluated Cofactor AI's platform and said, “Using Cofactor AI, an individual team member can prioritize, review, and appeal a denial in a few minutes. This lets providers and health organizations invest more time and more money in patient care, which is good for everyone.”
Cofactor AI was founded by Tantravahi and Juan Sebastian Lozano, CTO, in August, 2023.
About Cofactor AI
Cofactor AI helps hospitals easily, quickly, and successfully appeal claims denials. Hospitals can learn more and request a demo at www.cofactorai.com.
Josh Inglis josh@propllr.com 312.504.7677
