Xsolis Launches Generative AI Solution to Streamline Peer-to-Peer Reviews Following Payer Denials
New Dragonfly capability automatically creates a clinical synopsis to help physician advisors prepare for time-sensitive payer conversations
Xsolis has launched a generative AI capability designed to help physician advisors prepare more efficiently for peer-to-peer conversations with health plan medical directors following patient-care denials.
The GenAI Peer-to-Peer Clinical Synopsis is now generally available within Xsolis’ Dragonfly Advise platform. The capability automatically reviews patient records and creates a concise clinical summary highlighting information relevant to medical necessity and continued inpatient care.
Peer-to-peer reviews often occur within 24 to 72 hours of a denial, leaving physician advisors limited time to review complex medical records and prepare their case. Xsolis cited American Medical Association data showing that nearly half of physicians who do not pursue an appeal identify limited time or staff resources as a factor. KFF data indicates that more than 80% of formally appealed denials are ultimately overturned.
The new capability scans medical records for key clinical information, including laboratory results, vital signs, treatments and patient progress. It then organizes those findings into a patient overview and day-by-day summary of clinical severity indicators and medical necessity rationale.
The synopsis is generated automatically when a peer-to-peer review is escalated within Dragonfly Advise, helping physician advisors quickly identify the most relevant information before speaking with a payer.
“Peer-to-peer reviews are among the most time-sensitive points in the denial process,” said Joan Butters, co-founder and CEO of Xsolis. “By bringing the most relevant clinical facts forward, we can reduce the work required to reconstruct the case.”
Xsolis said several health systems have signed agreements to incorporate the capability into their utilization management and physician-advisor workflows, with implementations planned in the coming months.
The launch marks the third generative AI capability Xsolis has introduced within Dragonfly. Previous capabilities support appeal-letter preparation and medical necessity reviews.
In a three-month pilot with Beacon Health System, Xsolis said its medical necessity review solution reduced average review time by 68%, from 15 minutes to 4.7 minutes.
The GenAI Peer-to-Peer Clinical Synopsis is available as an add-on to Dragonfly Advise at the hospital or facility level. Future enhancements are expected to make the synopsis available within other systems used by physician advisors during peer-to-peer conversations.
