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Microsoft has announced the availability of a claims denial navigator tool.
The free, AI-powered tool was developed by Microsoft Partners and rural health leaders from the Rural Health AI Innovation Lab (RHAIL).
It allows hospitals to handle denied claims and receive reimbursement faster. It is available in the GitHub Models catalog.
WHY THIS MATTERS
The AI claims denial navigator is available for any healthcare provider, from small rural clinics to large urban health systems. Microsoft and RHAIL are targeting the rural providers who face financial hurdles due to denied insurance claims.
While many denied claims are eventually approved, the average cost of managing denied claims for a small hospital is estimated at $330,000 annually, Microsoft said. Statistical analysis shows that rural hospitals have a denial rate of 18%, far higher than the 10% rate for urban hospitals.
The claims denial navigator streamlines resolution processes for denied Medicare, Medicaid and commercial insurance claims. It offers recommendations for the most effective actions billing staff can take to resolve denied claims and learns from their actions and feedback to improve its recommendations over time, Microsoft said.
Rural hospitals face significant financial and workforce challenges. Microsoft cited a recent study that said that more than 700 rural hospitals across the United States are at risk of closure due to financial hardship.
THE LARGER TREND
Microsoft’s Rural Health Resilience Program is part of the broader Microsoft Elevate commitment, which focuses on providing access to AI tools and skills to create opportunity across various sectors, including healthcare.
In June 2024, Microsoft announced a cybersecurity program to support hospitals serving more than 60 million people living in rural America.
In 2023, the healthcare sector reported more ransomware attacks than any other critical infrastructure sector, and attacks involving ransomware against the healthcare sector were up nearly 130%.
In rural communities these attacks can be devastating, Microsoft said. Smaller, independent Critical Access and Rural Emergency hospitals have limited resources to prevent and remediate security risks.
ON THE RECORD
“After decades of working to improve healthcare access and equity, I’ve seen how systemic financial pressures threaten the survival of rural hospitals. The claims denial navigator represents a critical step forward — an AI-powered tool that empowers rural providers to recover revenue more efficiently, strengthen their financial footing, and continue delivering essential care to their communities,” said Dr. Jim Weinstein, senior vice president Microsoft Health—Innovation and former director of the Dartmouth Institute and CEO of Dartmouth Health.
Email the writer: SMorse@himss.org