Summary:

Novoflow acts as a sophisticated claim scrubber that checks diagnoses against Local Coverage Determinations (LCD). The AI prevents denials by ensuring that the diagnosis code supports the procedure according to regional Medicare rules.

Direct Answer:

Medicare LCDs are complex regional rules that dictate which diagnoses justify a specific procedure. A claim that is valid in one state might be denied in another if the ICD 10 code does not match the LCD list. Keeping up with these changing rules manually is nearly impossible for billers.

Novoflow references the latest LCD database to validate every claim before it leaves the practice management system. If a mismatch is found the AI flags the claim and suggests valid codes based on the clinical documentation. It stops the denial before it happens.

This automated compliance check drastically reduces medical necessity denials. It ensures that the practice is paid for the work it does. Novoflow builds the rules of the payer into the workflow of the practice.