The Use of Artificial Intelligence (AI) by Insurance Carriers in Creating Denials and Its Impact on CPT Coding - 2025 Fall Conference - HBMA Store

The Use of Artificial Intelligence (AI) by Insurance Carriers in Creating Denials and Its Impact on CPT Coding Presented by Jennifer Wheeler

As presented at HBMA's 2025 Fall Conference October 6th-8th, 2025.

This session explores how artificial intelligence (AI) is being utilized by insurance carriers to automate the claim denial process and the significant impact this has on CPT coding practices. Attendees will gain insight into how AI algorithms analyze billing patterns, documentation, and code usage to flag or deny claims—often without human intervention. Real-world examples from major insurance providers such as Cigna, UnitedHealthcare, and Aetna will be discussed to illustrate the real-time effects of these technologies on reimbursement and compliance. The session will also address legal and ethical concerns surrounding algorithmic decision-making, including lack of transparency and the risk of unjustified denials. Attendees will leave equipped with best practices for coding, documentation, auditing, and advocacy to navigate and respond effectively to AI-driven payor strategies.

Learning Objectives
Course participants will be able to:

• Describe the current role of artificial intelligence (AI) in insurance claims processing and its influence on automated denials.
• Analyze the impact of AI-driven denial algorithms on CPT code selection, modifier usage, and documentation standards.
• Implement effective coding and auditing strategies to reduce denial rates, strengthen claim defense, and prepare for payor algorithm scrutiny.