Artificial intelligence has emerged as a very disruptive force in the business world. It has an incredible ability to mimic the way humans think and learn, meaning that the way it identifies patterns and analyzes data only improves over time. The healthcare insurance industry is a surprising benefactor of this AI wave, particularly in the realm of insurance claims submission.
Traditional Approaches
The traditional claims submission process is very costly and time consuming. There are a significant amount of claims that get denied, and 27% of them are denied early in the patient registration phase. This means that the claims are not denied because they are not covered, but because there is some misreported information by the employees entering the data. In fact, the average human error rate is 19.3%, which can mean inaccuracies in selecting the correct payer ID or inputting patient information incorrectly.
The problem is made worse by the complex requirements of insurance card capture processing, which mostly depends on human knowledge to browse and enter important data. Insurance cards lack important information so human data input is unavoidable. Also different insurance providers enforce strict state, local, and ZIP claim process rules, which further complicate things. Current digital intake methods, such as optical character recognition (OCR), are unable to report information that is not found on the insurance cards, which causes errors and delays.
Conclusion
AI might be the solution to all of these problems. They have been refined on large datasets with a variety of insurance plan types and payers so they are able to verify data in as little as five seconds. This is a striking improvement from the five to fifteen minutes that manual processing takes. They are also more accurate in information reporting, which can save up to $25 per reworked claim. These improvements in cost and efficiency will be extremely coveted in this industry in the near future.
Source: OrbitHC
