ALFRED: Transforming Health Claims using AI
Transforming Health Claims using Data Intelligence, Risk Insights and Automation: AI Risk, Decision & Auto Adjudication Platform
COVID-19 has changed people’s perspective as how important is insurance protection for self, family, employee and business.
Health Insurance is fundamental need now than just a protection. The important aspect in health insurance is to have claims process easy, smooth and digital. About US $61 Billion out of US $91 Billion in 2019, was spent as out of pocket expenses. Health Insurance needs transformation from legacy to build new age digital, personalised, connected and automated processes from filing, tracking to final settlement using AI, ML & Learning. There are many problems that exists in health claims process, some of them are:
Problems in Health Insurance Ecosystem
Patient find it difficult to file claims specially due to lack of awareness and also challenge in terms of what is needed and what to submit for claims?
Patient sometime don’t understand what is covered or what is not covered?
>60% Health access are costly and have no access to health insurance protection
Digitization of Healthcare, Access to right health insurance products based on need is challenge. Mental Health, Health advisory is still biggest challenge.
What Artivatic is doing in Health Insurance Claims Transformation?
Artivatic is an full-stack InsurTech that focuses on building new-age insurance & health solutions to solve the need of its customers and transforming in to digital claims process. Artivatic has built health insurance stack to have 360 ecosystem in place.
Artivatic’s ALFRED- AI Health Claims Platform is building 360 health ecosystem using tech & data to transform how real-time claims process can be settled. The important aspect of real-time claims settlement is to build connected journey to patients, providers and payers.
Unified Health & Insurance Platform
Unified Platform for Patients/Providers/Payers for using AI to Analyse pre-existing medical history, Disease prediction and recommendation for patients & providers and providing same info to payers for better health protection.
Document Digitization & Health Analysis
Processing Medical documents, billing, discharge summary and more. Analysing pre-existing medical history, Disease prediction and recommendation Reports/Analysis/Digitization.
Patient Advisory, Wellness and Risk Scoring
Mental Health /Reducing health/medical/operation costs & Real time Risk identification. Lifestyle/Wellness mapping with new health devices and past clinical/diagnosis data to provide health risk recommendation, preventive healthcare to reduce medical costs & improving life.
Seamless Claims Pay-out. Access to Health Financing.
Instant unified AI Platform for claims assessment and pay-out connected with insurance /provider platforms. Access to Health Financing via Credit/Loyalty Cards/Low cost medical /health services on provider/patient side using risk based analysis & decision.
ALFRED: AI Based Health Claims Solution Benefits:
Cashless + Reimbursement+ OPD + Hospicash + Loyalty Cards
Automated Medical documents digitization [Printed, scanned, Handwritten] > 90% Accurate
Reducing TAT up to 90%
Indexing system for medical records, billing, and other data to provide better risk assessment in real time, UP 50% better risk assessments
Fraud & abuse detection >30%
Connected ecosystem via APIs for patient, provider and payers - Easy Integration
Product config and rules edit engine - retail /group
Automated Medical Billing/Coding - IRDA/ICD10 etc.
Digital Pre-Auth and claims processing journey with digital consent process
Integration of NDHM for request for health data
Real time claims status update, share documents etc. without sending over email/whatsapp etc.
Real-time decision making engine for patients, providers and payers via Auto-adjudication and claims denial solutions
Self learning and evolving system for better risk assessment, fraud and decisions making
Workflows and Payment systems Integrated
Easy customized to the need for use to connect to any core claims system or use independently
Build health network digitally and assign benefits for health insurance products
Digital Tarif/SOC management system for approval, update and use [Without investing time for hospital manual contracts, record and negotiation]
Artivatic is aiming to provide 360 health claims network and automated solutions for provider, TPA, Insurance businesses and patients.
Interested in Demo, click here: CLICK HERE. [Request for Password/Demo]
Read More here about Health Claims: https://alfred.artivatic.ai/blocks/ai-health-claims/
Find out at AZURE for Health Claims: ALFRED AI HEALTH CLAIMS ON AZURE
Interested to know more, write to firstname.lastname@example.org and Artivatic will get in touch with you.