Workflow costs reduced by 68%, improved quality and reduction in turnaround time by 72%.
Medical claim queries are highly complex workflows that are often free form, without clear or simple structure. These queries may be initiated by multiple parties such as patients, providers and lawyers. Documents are as large as 100 pages with dense, complicated medical claim and diagnostic information. Medical claim queries are also subject to a wide range of regulations from patient privacy to requirements for accuracy and turnaround time.
The Client Challenge
Smart Data Solutions stepped in to help a client get control of an internal and manual medical claims
processing workflow that was both problematic and costly. The workflow output included indexing, categorization and identification of tonality. The manual workflow was problematic for three main reasons:
- Required high skill human analysts
- High complexity resulting in errors
- Daily volume variability resulting in intermittent staff idleness and production backlogs
The SDS Solution
Smart Data Solutions gave the client’s complex workflow a better than human brain solution by leveraging proprietary AI and machine learning capabilities to automate the majority of the workflow. The agility, speed and self-learning qualities of the SDS system resulted in improved automation and quality over time.
The client’s overall workflow costs were reduced by 68% while quality improved. An important objective also was achieved in terms of regulatory compliance. Turnaround time for processing of medical claims queries was reduced by 72%.