CliniAId | COVID-19 Claim Automation

Approve COVID-19 Discharge Claim in 30 minutes

Insurance documentStethescope
300 Data Points
analysed per claim
300%
Increase in productivity
50-80%
reduction in cost

COVID-19 Claim Automation

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.

Current Challenges
Challenge

Due to the uncertainty, COVID-19 claims are 3-times higher than average claims

Solution

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.

Challenge

COVID-19 claims need 70-100% more average handling time (AHT) than usual claims.

Solution

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.

Challenge

COVID-19 has overwhelmed the healthcare industry making it extremely difficult to manage customer expectations.

Solution

The solution is highly scalable and can accommodate a sudden rise in the number of claims with relative ease.

Challenge

Huge variations in treatment depending on comorbid conditions, severity of the condition & cost.

Solution

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.

Higher Cost
>
Challenge

Due to the uncertainty, COVID-19 claims are 3-times higher than average claims

Solution

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.

Higher Handling Time
>
Challenge

COVID-19 claims need 70-100% more average handling time (AHT) than usual claims.

Solution

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.

Customer Expectations
>
Challenge

COVID-19 has overwhelmed the healthcare industry making it extremely difficult to manage customer expectations.

Solution

The solution is highly scalable and can accommodate a sudden rise in the number of claims with relative ease.

Variation in Treatment
>
Challenge

Huge variations in treatment depending on comorbid conditions, severity of the condition & cost.

Solution

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

Modules
Summarise icon

Summarise

  • Summarise & validate claim documents

  • Extract medical and invoice data from all documents

  • Summarise payable amounts and clinical findings

Standardise icon

Standardise

  • Assign SNOMED code to medical, and Bill head to invoice data

  • Parse diagnostic reports to validate medical findings

  • Identify severe and comorbid conditions

Intelligence icon

Intelligence

  • 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

Features
Pretrained Models icon
Pretrained Models

Pre-trained AI models that process medical data from any hospitals

Financial Adjudications icon
Financial Adjudications

Adjudicate financial data with more than 95% accuracy

Medical Adjudication icon
Medical Adjudication

Adjudicate medical data including automated detection of severity and comorbidity

New-age dashboard icon
New-age dashboard

Effective management of claim submissions process via one interface

Flag FWA cases icon
Flag FWA cases

Flag potential FWA accounting for factors like comorbidity, severity, hospital type, etc.

It gets simpler
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