COVID-19 Claim Automation

The COVID-19 pandemic has transformed the healthcare industry. Insurers are finding it difficult to process 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 adjudication of claims.

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. It helps in handling an unexpected increase in the number of claims by automating medical adjudication.

The solution is highly scalable and can accommodate a sudden rise in the number of claims with relative ease. 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 average handling time. There are also huge variations in treatment depending on comorbid conditions, severity of the condition and cost. 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 and further simplify the process.

  • Pretrained Models: Pre-trained AI models that process medical data from any hospital
  • Financial Adjudication: Adjudicate financial data with more than 95% accuracy
  • Medical Adjudication: Adjudicate medical data including automated detection of severity and comorbidity
  • New-age dashboard: Effective management of claim submissions process via one interface
  • Flag FWA cases: Flag potential FWA accounting for factors like comorbidity, severity, hospital type, etc.

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