In the intricate web that is the healthcare landscape, processing millions of claims with precision poses a lofty challenge for both payers and providers. As the volume of claims surges exponentially, traditional manual methods struggle to keep up, leading to delays, errors, and increased operational costs. However, scalable AI solutions offer a transformative opportunity to streamline claim processing, enhance accuracy, and boost operational efficiency.
In this blog, we’ll explore the potential of AI in making this transition seamless and efficient.
The Challenge of Claims Processing
Claims processing is no easy feat! Involving adjudication, submission, payment, and ultimately processing, this multi-step procedure is error-prone and fraught with complications. Healthcare organizations process millions of complex claims every day from sources like hospitals, clinics, pharmacies, and laboratories.
According to a previous report by the American Medical Association, the average doctor spent 8.7 hours per week, 16.6% of working hours on administration including claims processing.
The sheer volume and complexity of claims, coupled with evolving regulatory requirements and reimbursement models, make manual processing extremely inefficient resulting in increased errors and operational costs, delayed payments, and dissatisfied patients.
A 2020 Change Healthcare Revenue Cycle Index report revealed that 11.1% of claims were denied upon initial submission while 30% of healthcare leaders say that claims denials are increasing at a rate between 10 to 15%.
Claim denials can be a major headache for healthcare organizations as denied claims take much longer to pay out than first-time claims. In some cases, they don’t get paid at all. A study found that unresolved claims denials represent an average annual loss of $5 million for hospitals!
Addressing the Challenge with Healthcare AI Tools
AI-powered solutions offer a scalable and efficient approach to processing millions of claims by automating repetitive tasks, analyzing vast datasets, and extracting actionable insights.
Machine learning algorithms can swiftly identify patterns and anomalies in claims data, allowing organizations to detect fraud, waste, and abuse more effectively while Natural Language Processing (NLP) techniques can decipher unstructured claims data to extract relevant information and facilitate faster adjudication.
Moreover, predictive analytics models can forecast claim volumes, resource requirements, and reimbursement trends, enabling proactive decision-making and resource allocation.
Felix Solutions offers patented document intelligence solutions that leverage AI, ML, and NLP to extract data from unstructured documents with an accuracy rate of 99%. These cutting-edge solutions empowered to process 1,000s of contracts a day against code compliance, insurance provider rules, and individual plan coverage, are designed to address the challenges of processing millions of claims efficiently and accurately.
With features like contract ingestion and EOB digitization, Felix Solutions enables healthcare organizations to streamline claims processing workflows, optimize revenue management, and improve operational efficiency at scale. Felix’s EOB Digitization tool works 250% faster than manual processes, allowing clients to upgrade from processing 4 contracts a day to 1,000 contracts a day! Felix’s Contract Ingestion solution uses AI and ML technologies to automate the claims process, reducing the risk of errors, improving contract management, and providing a comprehensive view of contract terms.
By streamlining the process and centralising the contracts into a single easily accessible repository, Felix’s EOB and CI tools save time and resources, while ensuring compliance, and minimizing risks for organizations. Additionally, with automated processes and optimized workflows, the contract turnaround time is also greatly reduced, resulting in higher efficiency and faster contract negotiations and reimbursements. Lastly, the system follows strict compliance and security standards, ensuring that healthcare providers’ sensitive contract data is always protected.
Moreover, Felix Solutions’ scalable architecture and flexible deployment options ensure seamless integration with existing systems, enabling organizations to realize the full potential of AI-powered claim-processing solutions.
Conclusion
The global healthcare claims management market valued at USD 21.64 billion in 2021, is set to grow at a CAGR of 23.4% from 2022 to 2030, driven by increasing healthcare expenditures, rising claim volumes, and the need for accurate processing solutions.
The adoption of AI in insurance claim processing is bound to benefit all the stakeholders in the healthcare ecosystem in the way of quicker reimbursements, saving time and operational costs and fraud detection. As healthcare organizations strive to enhance claims processing efficiency, reduce costs, and improve revenue integrity, partnering with Felix Solutions offers a compelling opportunity to achieve these objectives.
By harnessing the potential of Felix Solutions’ AI tools, you can streamline your claims processing workflows, reduce operational costs, and accelerate reimbursement cycles to ultimately enhance the financial health of your organization. For more information, write to hello@felixsolutions.ai.