Automating End to End Health Claims using AI & Data: ALFRED HEALTH CLAIMS

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 contact@artivatic.ai and Artivatic will get in touch with you.