Optimizing Health Insurance Claims Processing: The Role of Clinical Documentation Improvement (CDI)

Background and Objectives: Clinical Documentation Improvement (CDI) programs have been identified as a financial risk reduction strategy and are becoming increasingly important in payer-provider alignment. This study aimed to evaluate the effect of CDI on insurance claim denials in the context of the healthcare sector in Saudi Arabia and the Vision 2030 healthcare transformation plan. Methods: A cross-sectional study of secondary data from two public healthcare facilities in Eastern Saudi Arabia. A total of 203 insurance claim denials (2023-2024 data) were analyzed. Denial reasons, CDI implementation, and patient characteristics were the study variables. Results: =119.152, p<0.001). Conclusion: CDI implementation is associated with a substantial reduction in documentation-related insurance claim denials and policy and billing issues. This study highlights the role of documentation in financial risk reduction and the importance of CDI implementation in healthcare facilities in the context of the healthcare sector in Saudi Arabia and the Vision 2030 healthcare transformation plan.