Turbocharge claims pre-approval team

Challenges

Our healthcare client was looking to improve their claims pre-approval process. 

Traditionally, professional submit for pre-approval, but never filter the medical documents required for claim submission. 

This increases the workload of the pre-approval team as they need to filter through every medical  document of the member seeking pre-approval for a claim.

Solution

Our client engaged HyperAspect’s Cloud platform to help develop a decision support system that allows any medical professional to quickly see all documents important to the procedure and automatically highlight important sections within the document.

The approach involved creating a decision support system that fully integrates with the existing pre-approval workflow, funnels all document submissions into a centralized system, and appliesdifferent approaches from natural language processing to understand the document and text context. 

After the contextualizing phase, the system uses a series of AI comparison techniques to understand exactly which pieces of the unstructured text is relevant to the claim procedure and visualizes key information.

Results

Once the system was deployed and proper training provided to the pre-approval team, the total duration for evaluating a single claim dropped from 1.5 hours to just 30 minutes. This dramatic increase in efficiency guarantees better and faster service for the claims that need it most.

  • Reduced claims processing time by 1 hour
  • Improved employee effectiveness by 25%
  • Increased customer satisfaction by 45%

 

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