Intelligent Process Automation in Insurance — Handling Medical Claims

Manual Paperwork is Error-Prone

Part of the problem is the sheer volume of paper and document-based processes that precede the final step of approval for reimbursements. Most of this paperwork comes in the form of unstructured data, making it difficult to export it directly into line-of-business applications and content management systems. Traditional claims management has always involved manual data entry and processing work, which is time consuming and laborious. Manual effort is often error-prone — one wrong detail and you could be overpaying or underpaying.

Why is Intelligent Automation Such a Big Deal?

Although established payers have taken the plunge and resorted to adopting cognitive technologies like AI and Machine Learning for elevating the accuracy and speed of investigation and underwriting, the back-office has remained more or less traditional. It’s time to change this. The potential and returns from optimizing mission-critical processes in the insurance sector like claims processing and data entry is tremendous — simply by using Intelligent Process Automation (IPA) to process medical bills and corresponding reports, this trust catering to the health and human services industry has improved productivity and processing times by leaps and bounds. From handling 120 medical bills per day, they now process almost 300 in one day. Also, the processing times have come down significantly from 60-90 days to now, 24-48 hours, for a workload of 4000 bills per month. AI improves productivity of mission-critical processes and businesses often notice considerable returns within six months of deploying the software.

Benefits of IPA: Medical Claims Processing Software

We further explore what makes Intelligent Process Automation a feasible solution among growing companies and why are even SMBs, which cater to a niche market segment, opting for digital transformation using this technology. Here are some of the immediate benefits that make IPA a must-have for growth-focused companies:

• IPA removes the drudgery from unstructured document processing: data from unstructured documents like claims forms and medical reports must be entered into a medical billing solution or claims management software for further processing. This is a repetitive, time-consuming process that can be automated by IPA. IPA employs OCR/ICR technology along with Machine Learning (ML) to recognize and extract data fields from a claims document. IPA software assigns a specific workflow according to business rules to extract data, based on which the data is routed for auto-validation and for approval to a verification manager. IPA offers straight-through processing of medical claims forms from capture to final approval before entering the approved details to an ERP system or line-of-business applications for further use.
• Single Intelligent Platform Solution: a single, AI-and-ML-enabled platform solution performs capture, extraction, validation, approval routing, and export of claims data from any number of diverse claims document types to a line-of-business application for final deliberation, analysis, and approval for reimbursements.
• Self-learning Reduces Manual Intervention: IPA bots, much like RPA, have inbuilt logic to process standard claims forms with known data fields and field placements. But the similarity ends here. With RPA, users will have to create a new template for every new claims form. This is not the case with IPA technology, which employs machine learning to self-learn document types. The IPA bot learns manual keystrokes performed to input data from a new type of medical claim form the first time. It retrieves this learning for every subsequent form of a similar type and format and performs data entry autonomously. This self-learning ability of Intelligent Process Automation saves businesses the need to prepare templates for every type of document, extending the reach of IPA technology to any number of diverse unstructured document formats. Self-learning technology reduces manual intervention significantly.
• Reduces the Time & Costs of Processing a Medical Claims Forms: did you know employees spend almost 70% of their time in manual paperwork? This is a massive waste of employee skills and output. Intelligent Process Automation supports straight-through processing of unstructured documents, saving companies valuable time and manpower resources sorting, filing, and performing data entry work. Intelligence-based workflows perform auto-capture, auto-extrication, auto-validation, and auto-routing of documents for approval before sending approved documents to a claims management software or ERP. As you notice, there is little to no manual intervention between capture and export of claims to an ERP. This aspect of automated claims processing eliminates manual-based errors, which could cost companies in repeat processing and time. If, initially a company relied on 3 employees to manually perform data entry and processing of claims forms, with Intelligent Process Automation, the need for staff is completely eliminated, with manual intervention needed only during exception handling or verification.
• Expedited Reimbursements: nothing is more important to your claimants than receiving reimbursements quickly. Payer organizations know how critical timely reimbursements are to retain customers in the long-run. Medical claims processing software helps expedite claims processing. The solution hosts claims data in a common database and performs tasks on a common platform connecting payers, providers, and the greater healthcare ecosystem. This expedites the time-to-retrieve for documents in order to respond to customer queries and analyze claims forms.

Intelligent Process Automation of medical claims processing creates a positive working experience for employees, while ensuring timely customer service and reimbursements to claimants.

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