The Anomaly Smart Response engine leverages the power of artificial intelligence to reverse engineer payer-specific payment logic. Smart Response applies learnings from your own claims history, as well as from all Anomaly live customer and model training data, so our customers benefit from the "network effect" of this shared learning. SmartResponse powers three distinct applications:
- Predict: predicts line-level denials before a claim goes out the door. All predictions are payer-specific and include a predicted denial reason code, and in many cases, we go even further to recommend the next best action for securing payment. This check can be performed pre-billing, or farther ahead in the clinical workflow. Our response time is <10 milliseconds and is available for integration into the workflow via API.
- Detect: provides real-time monitoring and alerting of new denial trends and policy changes. These changes could reflect new payer level health policies, new secondary edits from payment integrity vendors, newly enforced payment rules, subjective interpretations of payment rules and errors on the payer side. Detect is delivered via on-demand reporting through our secure customer portal.
- Recover: generates immediate ROI by identifying and prioritizing unresolved denials with high likelihood of payment. Recover indicates target claims for resubmission or appeal with specific recommended actions for overturn and recovery. Recover is delivered in real-time via API integration, or can be provided via dashboard based on customer preference and workflow.
Seamlessly embedded into managed care and revenue cycle workflows, Smart Response provides real-time insights to optimize payments. It pinpoints payer behavior changes that impact revenue, strengthens contract negotiations, and enables proactive claims correction—so providers can fix issues before they lead to costly denials.
With Anomaly, healthcare payments become smarter, faster, and more transparent—ensuring providers get paid what they’ve earned.
