Hospitals Use AI Clinical Scoring to Streamline Utilization Review

In a Becker's Hospital Review recap of a conference panel sponsored by Xsolis, hospital executives from Kettering Health and PeaceHealth describe how AI-driven, real-time clinical scoring has changed utilization management workflows. The platform generates a continuously updating "Care Level Score" from EHR data to flag status mismatches, prioritize nurse reviews, and support concurrent authorization and payer appeals. Panelists reported faster review of admissions, reduced observation rates, and new payer-facing reports used to challenge denial patterns and negotiate pre-agreed payment thresholds with payers like Humana. The piece frames these changes as reducing the historic silo between clinical and revenue cycle teams.

Managed Care · Finance