Many factors make revenue cycle management (RCM) a big headache for U.S. health care providers.

In this interview with Healthcare IT Today, Aakarsh Sethi, Senior Product Manager at Infinx, lists the forms of “fragmentation” in payments: not just many different payers, but different plans with different coverage at each payer, along with pharmacy benefit managers (PBMs) and other third party managers, and rules that are constantly changing.

Stuart Newsome, VP of Marketing at Infinx, describes the company’s “intelligent payer mapping,” an LLM-based service that determines whether a procedure needs prior authorization, and then whether the patient’s condition and symptoms meet payer guidelines.

Infinx is taking a novel approach to mapping out a healthcare organization’s payers to make sure the list of payers is updated properly.  It’s done with a multi-modal approach, where the system cascades through clearinghouse connections with payer portal automations to fill in the gaps.

Watch the video for more or read the full Healthcare IT Today article here.