Friday at The National had a full programme, but one session produced the sentence people repeated in the hallway afterwards. Somewhere between your front desk and the reimbursement, there is now an algorithm, and it read your claim before any human did.
Our team member was in the room. This is what the session actually presented about AI and chiropractic claim denials, why it matters more than any of the friendlier AI topics at this event, and what a practice can practically do about it. It is the second report in our series from Orlando, following our day one notes on AI and practice operations.
Table of Contents
The Session That Said It Out Loud
Lisa Maciejewski-West's course, "AI: Superpower or Kryptonite? How AI is Transforming Healthcare Operations," ran Friday afternoon and was the most cautionary hour of the event so far. The programme listed it as clinical continuing education; in practice it was a tour of the machinery that sits between a chiropractic practice and getting paid.
What it covered
Machine learning, natural language processing, claims processing, prior authorization, coding, billing, AI-driven denials, privacy, and AI documentation tools. Not a futurist list. An operations list, which is exactly why it landed.
The tone mattered as much as the content. Most of what a practice owner hears about AI, on the expo floor especially, is optimism with a price attached. This was the other genre: a specialist in the unglamorous machinery of getting paid, explaining how that machinery has changed while most practices were not looking. Rooms listen differently to warnings than to pitches, and this one did.
The part that stopped the room
By our attendee's notes, the core of the presentation was this: payer algorithms can decide whether a chiropractic claim is processed automatically or pushed to review. The slides included an example where conflicting reimbursement policies led an algorithm to choose the rule that produced a denial, leaving the chiropractor to appeal manually. The software picked the payer-favourable reading, and a human had to spend hours unpicking it.
How AI Shapes Chiropractic Claim Denials
The presentation's most uncomfortable material was about denials that happen with little human review. Automated prior authorization, opaque payer algorithms, and cases where the provider may never learn precisely why the algorithm rejected the claim.
The asymmetry is the story
Hold the two halves of that picture together. The payer's side of the transaction is automated: eligibility, routing, review triggers, denial. The practice's side, the appeal, is still manual. One party spends milliseconds and the other spends an afternoon, and that imbalance is not an accident of technology adoption. It is what happens when one side of a negotiation industrialises before the other notices.
The economics behind it are worth stating plainly, because they explain why chiropractic claim denials will not drift back to the old normal on their own. A denial costs the payer approximately nothing to issue once the algorithm exists, while every appeal costs the practice staff time it can barely spare. Any system priced that way produces more denials over time, not fewer, and expecting restraint from it is not a strategy.
Why "you may never know why" matters
A denial with a stated reason can be corrected at the source: fix the code, fix the documentation, resubmit cleanly next time. An opaque denial cannot teach you anything, which means the same claim can fail the same invisible test repeatedly. For a practice, that converts billing from a process you can improve into weather you can only endure, and no owner should accept that framing without a fight.
What a Practice Can Actually Do
None of this is under a practice's control, but the response to it is. Three habits follow directly from what the session described, and none of them require new software.
Track your denials like a dataset
- Log every denial with its code, payer and stated reason. One spreadsheet row each. Patterns across twenty denials are visible in a way one denial never is.
- Ask for the reason in writing when it is not given. You will not always get a useful answer, and the asking still creates a record that matters on appeal.
- Watch the appeal clock. Automated denials arrive fast, and appeal windows do not extend themselves because the rejection was machine-made.
Then make the review a ritual rather than a reaction. Fifteen minutes at the end of each month with the denial log open: which payer, which codes, what stated reasons, what changed since last month. Most practices only look at denials one at a time, in the moment of irritation, which is precisely the view from which patterns are invisible. If the log shows one payer or one code driving most of the pain, that is no longer a billing annoyance, it is a specific, solvable problem, and the point where bringing in an experienced billing professional for one focused conversation earns its fee.
Write the note for two readers
The clinical note now has a second audience. The first reader is a human being, a colleague, an auditor, a lawyer someday. The second is software parsing it for the elements a payer's rules require. A note that is clinically excellent but structurally inconsistent can fail the machine reading, and per Friday's session, failing the machine reading increasingly is the decision. Consistent structure, complete required elements, the same fields in the same places every time: dull advice that has quietly become revenue advice.
The Same Technology, Pointed the Other Way
The session was not only a warning. It walked through the operational uses on the practice's side of the wall: automated eligibility checks, integrated claims management, coding assistance, and ambient clinical intelligence, where software listens during the doctor-patient conversation and drafts the clinical note for review. Tools named in the session included Nuance DAX and Amazon HealthScribe.
The upstream tools deserve particular attention, because a meaningful share of chiropractic claim denials begin life as eligibility problems: coverage that lapsed, benefits that changed, authorisations that were assumed rather than confirmed. Automated eligibility checking, run before the visit rather than after the rejection, prevents that entire category instead of appealing it, and prevention is the only move in this whole area where the practice, not the payer, holds the faster algorithm.
Buying carefully beats buying quickly
Naming those tools here is reporting on the session, not a recommendation. Anything that touches claims, coding or clinical conversations is a compliance-grade procurement decision, and the questions from our guide on what to ask before signing with any vendor apply with extra force: what does it cost in year two, who is already using it, and, for this category specifically, what happens to the audio and the data.
💡 Pro Tip
A one-line test for any billing or documentation AI pitch you heard on the expo floor this week: ask the vendor to explain, in writing, exactly what data leaves your practice and where it goes. A vendor who answers crisply is worth a second conversation. One who reassures instead of answering has answered.
Get my free video ad →The Boundary Held for the Third Session Running
Every AI session our attendee has covered at this event, Thursday's practice-management course and both of Friday's, ended at the same line: administrative and operational work is fair territory, clinical judgment and patient data are not. HIPAA and privacy were explicit sections of Friday's presentation, not afterthoughts.
That consensus is also a practical filter for whatever landed in your bag on the expo floor. Any product pitched this week can be sorted in one pass: does it automate operations, or does it reach for clinical territory and patient data? The first pile deserves the year-two-cost conversation. The second pile deserves considerably harder questions before it deserves any of your time, and the speakers at this event, without coordinating, just handed every attendee that sorting rule.
Why the repetition is the finding
One speaker drawing that boundary is a personal opinion. Every speaker drawing it independently, across different topics and different rooms, is the profession converging on a norm in real time. It matches the argument we made before the event in AI for chiropractors: this technology works as an amplifier for a real practitioner and fails as a substitute. Orlando spent two days agreeing.
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Get My Free Video Ad →One more resource worth naming: you are not the first practice to face this, and the appeal templates, payer-specific quirks and escalation routes largely already exist. State associations and experienced billing professionals deal in chiropractic claim denials daily, and an hour of their pattern-matching is frequently worth more than a month of a practice rediscovering the same lessons alone. Independent does not have to mean isolated.
If You Were Not in the Room
The practical summary for a practice owner who skipped Orlando fits in four lines. Your claims are being read by software before they are read by people. Your documentation is therefore being graded by software, whether you formatted it for that or not. The tools to automate your side of the transaction exist and are worth evaluating slowly, with compliance questions first. And the boundary every session kept repeating, operations yes, clinical judgment no, is as close to settled professional consensus as anything this new can be.
It is also worth saying what this does not mean. Nothing from Friday suggested abandoning insurance-based practice or treating every payer as an adversary. It described a negotiation in which one side quietly upgraded its tools, and the sensible response is neither panic nor denial but symmetry: track what they track, structure what their systems read, and automate your own side of the paperwork where it is safe to do so. Practices have absorbed harder operational shifts than this one.
What comes next
The event closes this weekend, and rising chiropractic claim denials driven by automation will outlast every booth in that hall, which is why this report came first. Our closing recap of the event, including what the quieter final sessions revealed and what the week adds up to for a practice owner, follows once the hall empties. The story of Friday, though, is already clear: the most important AI in chiropractic is not the one you might buy. It is the one that has already been deployed against your claims, and the practices that adapt their documentation and their denial tracking to that fact will simply get paid more reliably than the ones that do not.
