Savvy Appeal Workflow

Savvy Appeal Workflow Streamlining the denial appeal process.

05/27/2024

I argued with AI and eventually won.

You: Artificial Intelligence should be called “collective public knowledge”

Copilot:That’s an interesting perspective! Artificial Intelligence (AI) does indeed draw upon a vast amount of public knowledge. It learns and makes predictions based on the data it has been trained on, which often includes a wide range of information from various fields.

However, it’s important to note that AI is more than just a repository of information. It also involves complex algorithms that allow it to process, analyze, and generate insights from this data. This includes capabilities like natural language processing, image recognition, and predictive modeling, among others. So, while “collective public knowledge” is a part of what AI encompasses, the term “Artificial Intelligence” also reflects these additional capabilities. 😊

You: how is processing, analyzing, and generating insights from this data which uses the way this information is processed analyzed and generated not public knowledge when the Algorithm

is based on common thought processes

Copilot: You’re correct that many AI algorithms are designed to mimic human thought processes, and they do so by learning from publicly available data. However, the specific ways these algorithms process, analyze, and generate insights from data are often the result of complex mathematical and computational models that are not necessarily intuitive or transparent, even if they are based on “common” thought processes.

Moreover, while the data AI learns from can be considered “public knowledge,” the insights it generates from that data are often novel and not readily available in the public domain. For example, an AI might analyze a large dataset of patient information to identify subtle patterns that predict disease risk. These patterns are not “public knowledge” until the AI identifies them.

Finally, it’s worth noting that not all AI is trained on public data or generates insights that are shared publicly. Some AI systems are trained on private, proprietary datasets and are used to generate insights that are kept confidential. So, while AI does involve processing public knowledge, it also involves a lot of proprietary, confidential, and novel information and processes. That’s why we usually refer to it as “Artificial Intelligence” rather than “collective public knowledge.” 😊

You:"Moreover, while the data AI learns from can be considered “public knowledge,” the insights it generates from that data are often novel and not readily available in the public domain. For example, an AI might analyze a large dataset of patient information to identify subtle patterns that predict disease risk. These patterns are not “public knowledge” until the AI identifies them." AL defines its identification as original according to this statement, but it is still basing it's outcome on man-made ideas and processes. Therefore, it isn't novel

Copilot:You bring up a valid point. The term “novel” in the context of AI often refers to the new insights or patterns that the AI system is able to identify from the data, which were not previously known or understood by humans. While the underlying algorithms and processes used by AI are indeed man-made, the “novelty” comes from the AI’s ability to analyze vast amounts of data at a scale and speed that is beyond human capability, and thereby uncover insights that might have been missed by human analysts.

It’s also worth noting that while AI systems are designed based on human thought processes, they can often find relationships and patterns in the data that are counter-intuitive or unexpected from a human perspective. This is another sense in which the results of AI can be considered “novel.”

However, your point is well-taken. The term “novel” can be subjective and may vary depending on one’s perspective. 😊

You:"It’s also worth noting that while AI systems are designed based on human thought processes, they can often find relationships and patterns in the data that are counter-intuitive or unexpected from a human perspective. This is another sense in which the results of AI can be considered “novel.” A numerous group of people could do the work of data processing and arrive at the same conclusions as al. therefore ai is just a machine that get someone somewhere quicker than they can without the machine. similar to a car.

Copilot:You’ve made a great analogy! Just like a car can get us to our destination faster than walking, AI can process and analyze data much faster than humans. It’s a tool that enhances our capabilities, allowing us to make sense of large amounts of data and uncover insights more efficiently.

However, it’s also worth noting that AI can operate on a scale that’s often not feasible for humans. For instance, an AI can analyze millions of data points in a short amount of time, something that would be incredibly time-consuming, if not impossible, for a group of people to do. So, while a group of people might eventually arrive at the same conclusions given enough time and resources, AI can often get us there much more quickly and efficiently.

But at the end of the day, you’re absolutely right. AI is a tool, created by humans, to help us better understand and navigate the world. 😊

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Feeling lost in the denial appeal wilderness? Don’t worry, Savvy Appeal guides you through the dense thicket of document...
05/26/2024

Feeling lost in the denial appeal wilderness? Don’t worry, Savvy Appeal guides you through the dense thicket of documents step-by-step. Sign up for our newsletter, today: [https://savvyappeal.com/newsletter-signup/]

Newsletter Wed May 22
05/22/2024

Newsletter Wed May 22

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WAIT BEFORE YOU HANG UP, PRIOR AUTH IS MORE THAN JUST A NUMBER (make sure you have gotten these 12 prior authorization d...
05/17/2024

WAIT BEFORE YOU HANG UP, PRIOR AUTH IS MORE THAN JUST A NUMBER (make sure you have gotten these 12 prior authorization details).

Insurance Prior Authorization:

Name of Representative _______________________________

Date ________________. Time__________________ of request

Authorization number/code ____________________________

Authorized services and level of care___________________

Limitations on Scope or Duration: refers to what types of services are covered and for how long,

Method of obtaining authorization (phone, electronic) ____phone? __electronic?

Time Limitations: Prior authorization approvals are typically time-limited. This means the approval is only valid for a certain period, and if the service isn’t provided within that timeframe, a new prior authorization request may be required.

Quantity Limitations: refers to how much of a service or medication is covered. For example, an insurer might approve a certain number of sessions or a 30-day supply of a medication.

Service Limitations: Some services may require prior authorization under one health plan and not under another. Additionally, certain services might not be covered at all, even with prior authorization.

Provider Limitations: In some cases, prior authorization may only be valid if the service is performed by a specific provider or at a specific facility.

Clinical Criteria: Prior authorization often requires that certain clinical criteria be met before approval is granted. If the patient’s condition doesn’t meet these criteria, the prior authorization request may be denied.

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Documentation of the the above issues will help with denial appeals, should there be a denial for no authorization:

Changing Payer Policies: Payers frequently update their rules, making it hard to stay current.

Unclear Requirements: It can be unclear which services need prior authorization, leading to mistakes and confusion.

Gaps & Conflicts of Benefits and Eligibility: Understanding the benefits and eligibility of insurance plans is challenging.

Long Approval Times: The time taken for approval decisions can be lengthy, affecting timely patient care.

Exclusion of Prescription Drugs: Some policies do not cover prescription drug decisions. Sign up for our newsletter for many more tips

WHAT’S THE DIFFERENCE BETWEEN A REJECTED CLAIM AND A DENIED CLAIM?A rejected claim has never been processed by a clearin...
05/16/2024

WHAT’S THE DIFFERENCE BETWEEN A REJECTED CLAIM AND A DENIED CLAIM?
A rejected claim has never been processed by a clearinghouse, insurance payer, or the Centers for Medicare & Medicaid Services (CMS)—it’s not considered “received” and it did not make it through the adjudication (decision process) system.
A rejected claim contains one or more errors and fails to meet specific formatting, optometry billing and coding criteria, and data requirements. Once you fix the errors, you can resubmit the rejected claim.
A denied claim is a claim that has made it through the adjudication system—the insurance company or third-party payer received and processed the claim. However, even though a payer denies a claim, you can still appeal the claim as that doesn’t mean it’s not payable.
Payers will send you an Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) that explains why they denied the claim. Before you can correct the errors and resubmit the claim, you must determine why the claim was denied. That’s why it’s critical to brush up on claim denial and claim adjustment reason codes.
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Understanding and proving medical necessity -
05/15/2024

Understanding and proving medical necessity -

Proving medical necessity is the crucial aspect to overturning denials which are not based on coding or submission errors. It is a complex task. By registering for our website, you’ll gain access to a wealth of knowledge and resources that will help you navigate this complexity with ease.

Denials are painful. Savvyappeal.com can help walk you through a denied claim and get it overturned.
05/15/2024

Denials are painful. Savvyappeal.com can help walk you through a denied claim and get it overturned.

05/14/2024
05/09/2024

UPS sent me a message "We’re sorry this package has experienced a sortation delay. The package has been rerouted to the correct destination."

First time I have ever seen the word "sortation"....So, I looked it up.The history of the word sortation: Entry history for sortation, n. was first published in 1913; not yet revised. sortation, n. was last modified in July 2023.

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