The COVID-19 pandemic has transformed the healthcare industry. Insurers are finding it difficult to process the COVID-19 claims on time resulting in delays in the discharge process. This has accelerated the need for intelligent automation solutions to reduce the overhead of claims adjudicators and ensure faster & accurate claims.
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Due to the uncertainty, COVID-19 claims are 3-times higher than average claims
CliniAId helps in handling an unexpected increase in the number of claims by automating medical adjudication and being equipped to manage the end-to-end claims process.
COVID-19 claims need 70-100% more average handling time (AHT) than usual claims.
Using CliniAId-coded medical data and clinical rules prepared by Claim officers, the system can automatically validate the claim to achieve auto-adjudication of certain claim types which substantially reduces the AHT.
COVID-19 has overwhelmed the healthcare industry making it extremely difficult to manage customer expectations.
The solution is highly scalable and can accommodate a sudden rise in the number of claims with relative ease.
Huge variations in treatment depending on comorbid conditions, severity of the condition & cost.
CliniAid can extract medical data in claim documents to identify relevant details such as symptoms, diagnosis, treatment or procedures, medicines, etc. to help the medical officer check the medical admissibility of the case.
Due to the uncertainty, COVID-19 claims are 3-times higher than average claims
CliniAId helps in handling an unexpected increase in the number of claims by automating medical adjudication and being equipped to manage the end-to-end claims process.
COVID-19 claims need 70-100% more average handling time (AHT) than usual claims.
Using CliniAId-coded medical data and clinical rules prepared by Claim officers, the system can automatically validate the claim to achieve auto-adjudication of certain claim types which substantially reduces the AHT.
COVID-19 has overwhelmed the healthcare industry making it extremely difficult to manage customer expectations.
The solution is highly scalable and can accommodate a sudden rise in the number of claims with relative ease.
Huge variations in treatment depending on comorbid conditions, severity of the condition & cost.
CliniAid can extract medical data in claim documents to identify relevant details such as symptoms, diagnosis, treatment or procedures, medicines, etc. to help the medical officer check the medical admissibility of the case.
i3systems' CliniAId is an Intelligent Automation solution that enables insurers and TPAs to approve COVID-19 claims in 30 minutes by automating financial and medical adjudication. The solution is equipped with components to manage the overall claims process from accurate data ingestion to authorization and approval
Summarise & validate claim documents
Extract medical and invoice data from all documents
Summarise payable amounts and clinical findings
Assign SNOMED code to medical, and Bill head to invoice data
Parse diagnostic reports to validate medical findings
Identify severe and comorbid conditions
Intelligence models to cross-validate all the findings
Intelligence models to validate reasonable costs for given conditions
Highlight outlier or exception cases for expert review
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Pre-trained AI models that process medical data from any hospitals
Adjudicate financial data with more than 95% accuracy
Adjudicate medical data including automated detection of severity and comorbidity
Effective management of claim submissions process via one interface
Flag potential FWA accounting for factors like comorbidity, severity, hospital type, etc.
