i3claim | End-to-End Claims Automation Solution

Accelerate Claims Processing with Intelligent Automation

Image of an insurance professionalFilling form for i3claim
10 Lakhs+
Medical Claims Analyzed
90 Lakhs+
Medical Bills Digitized & Processed
3 Crore min
Manual Effort Saved

End-to-End Claims
Automation Solution

With increasing complexities and evolving consumer demands, digitisation of the claims process has become essential for insurers to ensure fast settlement & payment of claims as well as drive customer satisfaction and set standards of service. However, traditional claims processes involve intensive document-driven operations and the processing of non-structured data in multiple formats/nomenclature, making it difficult for insurers to process claims efficiently and quickly.

Current Challenges
Challenge

Traditional claims processes are manual and capture very limited data. This makes the process inconsistent and non-trackable, resulting in payment leakages

Solution

i3claim helps in capturing significantly more data-points in much lesser handling time. It reduces the extent of manual data capture and human errors in the entire claims process by more than 60%, making it much faster and extremely scalable.

Challenge

Data comes from multiple channels such as papers, electronic documents, images, and emails in a non-structured format.

Solution

i3claim accepts data input from a variety of sources like Hospitals, Pharmacies and Diagnostic centres. It extracts, classifies, and standardizes non-structured data present across multiple documents.

Challenge

Tariff agreement plans between insurers and hospitals are complex, data-heavy and complicated enough to be usable by only medical professionals

Solution

DigiTariff converts provider tariff agreements into structured data sets or excel sheets. Using DigiTariff, insurers can capture all items of a tariff agreement, while also standardising the expense items for price-comparison and analytics. The overall effort and cost would be 75% lower than the completely manual process.

Challenge

Due to manual processing, the average discharge authorisation is anywhere between 1-4hrs.

Solution

i3claim reduces the claims process to a single queue, by automating several parallel activities. This improves efficiency and leads to a reduction in cashless discharge time from 4 hours to less than 30 minutes for 90% of the cases

Challenge

Manually processing of invoices and complex tariffs lead to payment leakages to the tune of 3-10% of claim amount for every claim.

Solution

AI-assisted processing covers accurate capture of Non-payable and tariff comparison on 60% of the line-items. This has led to an average of Rs. 200-5000 savings per claim compared to manual processing.

Manual capture of limited data
>
Challenge

Traditional claims processes are manual and capture very limited data. This makes the process inconsistent and non-trackable, resulting in payment leakages

Solution

i3claim helps in capturing significantly more data-points in much lesser handling time. It reduces the extent of manual data capture and human errors in the entire claims process by more than 60%, making it much faster and extremely scalable.

Non-structured Data
>
Challenge

Data comes from multiple channels such as papers, electronic documents, images, and emails in a non-structured format.

Solution

i3claim accepts data input from a variety of sources like Hospitals, Pharmacies and Diagnostic centres. It extracts, classifies, and standardizes non-structured data present across multiple documents.

Complex Tariff Plans
>
Challenge

Tariff agreement plans between insurers and hospitals are complex, data-heavy and complicated enough to be usable by only medical professionals.

Solution

DigiTariff converts provider tariff agreements into structured data sets or excel sheets. Using DigiTariff, insurers can capture all items of a tariff agreement, while also standardising the expense items for price-comparison and analytics. The overall effort and cost would be 75% lower than the completely manual process.

Discharge Authorisation
>
Challenge

Due to manual processing, the average discharge authorisation is anywhere between 1-4hrs.

Solution

i3claim reduces the claims process to a single queue, by automating several parallel activities. This improves efficiency and leads to a reduction in cashless discharge time from 4 hours to less than 30 minutes for 90% of the cases

Payment Leakages
>
Challenge

Manually processing of invoices and complex tariffs lead to payment leakages to the tune of 3-10% of claim amount for every claim.

Solution

AI-assisted processing covers accurate capture of Non-payable and tariff comparison on 60% of the line-items. This has led to an average of Rs. 200-5000 savings per claim compared to manual processing.

i3claim is an intelligent automation solution that provides end-to-end claims automation.

It extracts, classifies, and validates over 300 data points in every claim document, reducing manual efforts, lowering costs by 50-80%, and making an accurate decision on every claim with a short turnaround time of 5 minutes.

Modules
Medical Adjudication icon

Medical Adjudication

  • Extraction and conversion of clinical data to codes

  • Identification of severe and co-morbid conditions

  • Care Package validation by Clinical AI models

Tariff Management icon

Tariff Management

  • Tariff Standardisation

  • Tariff Comparison

Billing Management icon

Billing Management

  • Extraction and Standardisation of invoice line items

  • Bill Head analysis

  • Identification of common non-payables

Features
Pretrained Models icon
Pretrained Models

100% pre-trained models ensuring no model training required

Template Agnostic icon
Template Agnostic

Efficient extraction of data irrespective of format or nomenclature

Rule-based Algorithms icon
Rule-based Algorithms

Comprehensive rule-based algorithms to detect unusual cases & alert claim officers to approve/reject a claim

New-age Dashboard icon
New-age Dashboard

Effective management of claim submissions process via one interface

Smart case routing & Allocation
Smart case routing & Allocation

Automated case routing to the next available adjudicator to ensure a speedy process

Seamless Integration icon
Seamless Integration

Seamless API-based integration with legacy or third-party applications

How i3claim works?
Diagram showing the process of how i3claim worksFlow chart showing how i3claim works
Benefits
Reduced TAT icon

Reduced TAT

Reduced TAT- Cashless claim discharge within 30 mins

Enhanced productivity icon

Enhanced productivity

300% improvement in FTE productivity

Accurate Identification icon

Accurate Identification

Accurate identification of non-payables

Fraud Detection icon

Fraud Detection

80% reduction in financial leakages

Scalable icon

Scalable

Scalable to 100% volume immediately,
instead of adding volume in phases

Intelligent Automation icon

Intelligent Automation

More than 95% of data captured
accurately via automation

i3Claim Adopters

Star Health Insurance
Liberty General Insurance
Bajaj Allianz
HDFC Ergo
Chola MS
<
01 /02
>
Chola MS
Aditya Birla Life
Reliance
ICICI Lombard
Medi Assist
<
02/02
>
Star Health Insurance
Liberty General Insurance
Bajaj Allianz
HDFC Ergo
<
01 /03
>
Bajaj Allianz
HDFC Ergo
Chola MS
Aditya Birla Life
<
02/03
>
Aditya Birla Life
Reliance
ICICI Lombard
Medi Assist
<
03/03
>
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