Automated Claims Processing (ACP)
Automate claims decisioning on complex health claims with high confidence
ACP automates claims decisioning on admissibility and adjudicates payable amounts accurately enabling near instant response to customers
Automate claims decision with high precision and recall
Process in real time and reduce the turnaround time drastically
Effective at various stages of claims from pre-authorization to discharge
Decreases the operational costs of the claims processing
Reduce time spent on complex claims through augmented inputs
With knowledge from claims history, ACP module provides data driven inputs to claims assessors thus reducing processing time for complex claims while maintaining decision quality.
ACP collates the learnings and provides data driven evidence for claim assessors
Augments the efforts required and improves productivity of claim assessors
Assists less experienced claims assessors to achieve decision quality and maturity
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Continuously improve automation coverage through feedback learning
Periodic retraining enables ACP module to learn new patterns from feedback to continuously improve overall coverage
Delivers increased coverage month on month
Analyses feedback from manually processed cases to improve overall coverage
Learns new behaviours without any changes to the system
Key Product Features
Process claims in near real time
ACP module produces inferencing results in near real time and scales on larger infrastructure as per required latencies
Claims Decisioning at various stages
ACP module can automate decisions at all stages of the claim life cycle Pre-Authorization or Discharge
Rapid implementation reduces the time to production
APIs are available that easily integrate with core workflow tools without minimal alterations to existing IT ecosystem
Comprehensive medical knowledge based built through unsupervised learning
ACP module is pretrained on standard medical nomenclatures like ICD 8/9/10/11 thus expediting training
Business controls that allow easy configurations
Business users can configure the module to define controls based on amounts, diagnosis, ICD.
Process claims in near real time
ACP module produces inferencing results in near real time and scales on larger infrastructure as per required latencies
Multi-user profile and role allocations
User profiles for the business head, manager & claim assessor. Customizable role allocation.
Easy to use dashboards to outline deep insights
ACP module produces inferencing results in near real time and scales on larger infrastructure as per required latencies
Automated Claims Processing (ACP) module – integrates with claims workflow through APIs. Easy, Fast & Secure.
Automate claims decisioning at various stages, from pre-authorization to discharge
Improve customer experience and satisfaction at all policy servicing touch points
Monitor and control claims leakage
Process & settle claims in real time
Assistive AI – autonomous AI system to continuously optimize the target strategy across different touch points
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