Why Hospitals Need AI UM Software to Fix the Denial Problem

This is the final part of a 3-part blog series on why outdated utilization management (UM) is costing your health system millions. Part 1 talks about the current state of denials and why they are increasing. Part 2 explains how to identify when you have a UM problem, and this part explains why you should consider AI-enhanced tools.

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Hospitals are under enormous pressure to protect revenue in an environment where insurance denials are escalating and payer requirements grow more complex by the month. Traditional utilization management (UM) systems, built on manual processes and fragmented technology, simply cannot keep pace with today’s demands. Hospitals seeking to combat the influx of denials and increase revenue are turning to AI UM software.

AI UM software leverages artificial intelligence to bridge gaps, prevent denials, and maintain financial health.

Why AI UM Software is the Answer

The rise of payer automation has changed the rules of the game. Insurers now deploy AI to comb through medical records and claims data in seconds, flagging potential discrepancies and issuing denials at scale. By contrast, hospitals often rely on UM nurses juggling multiple portals, spreadsheets, and EHR screens, trying to apply payer rules that seem to shift daily. The mismatch is stark.

AI UM software levels the playing field. It doesn’t replace the clinical judgment of staff; instead, it empowers them with real-time insights, automated prioritization, and predictive intelligence that expose risks before claims are submitted. Rather than spending valuable time reacting to denials after the fact, hospitals can prevent revenue leakage up front.

Optimized workflows capture millions in revenue that would otherwise slip away, all while giving teams the tools they need to work smarter, not harder.

Introducing IodineUM: An AI-Enhanced Solution Specifically for UM Teams

IodineUM is a next-generation UM solution that utilizes machine learning (ML), large language models (LLMs), and natural language processing (NLP) to transform the way hospitals manage patient status, clinical documentation reviews, and revenue capture.

• Real-time intelligence for confident decision-making: IodineUM continuously analyzes the full patient record, scanning for status gaps and other necessary corrective actions before they impact your bottom line. Using AI-powered prioritization, the platform surfaces a real-time, ranked list of high-risk cases, directing your team to what matters most—based on both clinical content and payer-specific rules.
• Seamless collaboration across teams: Effective utilization management is a team sport. IodineUM fosters cross-functional collaboration among UM, clinical documentation improvement (CDI), and physicians, ensuring that patient stories are complete, accurate, and well-documented from the outset.
• Built for revenue integrity: Every decision made in UM can impact reimbursement. IodineUM ensures your hospital receives accurate payment for the care it delivers by helping you prevent administrative denials, establish medical necessity, expedite appeal cycles, and capture the full revenue you deserve.
• Efficiency that scales with you: IodineUM helps your team work faster and smarter without sacrificing accuracy.
• Compliance built into every step: Payer rules are complex and constantly evolving. IodineUM reduces compliance risk by automatically tracking payer requirements, helping your teams satisfy payer expectations more readily and promptly.

Teams using IodineUM see review times reduced by 50% or more from 15-20 minutes to just 5-7 minutes per case.

It’s Time to Combat Denials with Iodine UM

Hospitals can’t afford to fight payer automation with outdated workflows. AI UM software like IodineUM equips teams with the intelligence, efficiency, and compliance support they need to stay ahead of denials and protect margins. By modernizing UM processes, hospitals not only recover revenue that would otherwise be lost but also give staff the tools to work smarter and more effectively. The message is clear: investing in AI-driven utilization management is no longer optional—it’s the key to building financial resilience in an era where every claim counts.

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