The Next Applied
social share alt icon


US-BASED HEALTHCARE SERVICES COMPANY TRANSFORMS CLAIMS ADJUDICATION PROCESS WITH MPHASIS.AI’S GENERATIVE AI SOLUTION

  • Home
  • US-based Healthcare Services Company Transforms Claims Adjudication Process with Mphasis.ai’s Generative AI Solution

CLIENT

 

Our client is a US-based healthcare services company with more than 375 corporate clients across the globe. Powered by platform-based and data-driven health technology, the client processes ~118 million claims every year, adhering to stringent regulatory norms — enabling employees of corporates to make clearer choices and avail benefits through spending accounts.

THE REQUIREMENT

The client looked to integrate the claims processing process with high efficiency and compliance. They needed to remove the

  • User bottlenecks of complex documentation and long adjudication periods
  • Claims processor issues of manual processing of poor claims data
  • Client’s high operating costs, risk of non-compliance and fraudulent claims

SOLUTION

 

With employee health and well-being taking centerstage, organizations look to provide the right resources to the employees to achieve these objectives - from hire to retire. The power of data, combined with AI-driven interventions can deliver timely and connected insights for better outcomes for your people and business.

Mphasis delivered a data-driven and Generative AI-powered solution with the following five interventions:

  • Automation of data extraction and processing from multiple documents, form filling and exception flagging

  • Efficient classification and pre-verification of supporting documents such as invoices, receipts and prescriptions

  • Gen-AI based determination of eligibility against applicable policies

  • AI-led claims validation and adjudication

  • Simplification of workflow processes through automation to eliminate process bottlenecks, manual entries and duplicate storage of data

BENEFITS

 

Our solution enabled the client to experience a tremendous surge in the average turnaround time from 3-5 days to just 5 hours. This included:

Slashing of submission times - from 30 minutes-1 day to just 10 minutes

Significant reduction in classification and processing times - from 2 days to 2 hours

Highly improved validation and adjudication timelines - from 1-2 days to 2 hours