Industry News | 07.22.25
Kansas Hospital Sues Blue Cross and Blue Shield of Kansas City Over AI-Driven Claims Denials
By NAMSS Staff
Healthcare IT News (07/14/25) Fox, Andrea
Advent Health Shawnee Mission Hospital is suing Blue Cross and Blue Shield of Kansas City for artificial intelligence-driven technology that the provider said audits claims and overrides physicians' wisdom on needed patient care. Additionally, the Kansas-based hospital is seeking damages for how the payer's alleged withholding of payments for patient care has impacted the organization. Shawnee Mission's lawsuit cites around 350 cases where Blue KC deemed diagnoses "clinically invalid and unsupported," per the clinical validation technology, which the hospital said places too much emphasis on complications and comorbidities in order to deny the claims. The payer uses the Apixio platform, which analyzes structured and unstructured data to develop patient health profiles for automated claims analyses.
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