Call it necessity or ingenuity, Artificial Intelligence(AI) has made a huge leap to practical reality.The outbreak of Covid-19 accelerated the frenzy around technological transformation. Theleaders and decision-makers in the healthcare industry — the most affected sector in thepandemic — have put the thinking cap on to make the best use of AI now and in the future.It would not be an understatement to say that health insurance providers have, so far, onlysurfed over the waves of AI. A deep dive is yet to take place. The use, as of now, is limited tostandard business processes and automate repetitive tasks.<\/p>\n\n\n\n
The C-suite level and the board is apparently keen on taking some of the most criticaloperations to AI and obtaining a cutting edge. By now it is quite clear that upon availability ofrobust data, there will be a large scope for AI application for payers.For health plans, at the advanced level, AI can be used broadly for compliance and next-levelclaim handling, according to a report by Deloitte.Let\u2019s have a close look at how the two critical operations can be handled more efficiently andsuccessfully with AI.<\/p>\n\n\n\n
Next-Level Claim Management<\/strong><\/p>\n\n\n\n From prior-authorization, revenue cycle optimization to submission and error-free service delivery, AI promises all when it comes to handling claims.<\/p>\n\n\n\n Rely on AI for:<\/strong><\/p>\n\n\n\n 1<\/strong>. Input and data extraction: With zero-level manual involvement, the robotic process automation tools can efficiently handle large volumes of data for information input or extraction.<\/p>\n\n\n\n 2<\/strong>. Real-time updates: Both the payers and clients can get real-time status updates on claimswith AI.<\/p>\n\n\n\n 3.<\/strong> Real-time insights: Data analysis through AI tools lead to real-time insights into filed claims quickly and accurately without human error.<\/p>\n\n\n\n 4.<\/strong> Claims confirmation, denial, follow-ups: Leave the tension of manual processing behind with AI-enabled automated claim cycle and retain little or no staff.<\/p>\n\n\n\n AI tools facilitate deep analysis and aggregation of data in handling issues of compliance and risks. The machine learning can be utilized to get the next best action and combination of tentative actions.<\/p>\n\n\n\n Rely on AI for<\/strong>:<\/p>\n\n\n\n 1.<\/strong> Real-time policy changes analysis: Measure the policy changes impact in real-time by employing natural language processing. Easily find out what, why, when and how of the policy change.<\/p>\n\n\n\n 2.<\/strong> Risk area multi-source analysis: Know critical risk areas for compliance. Also, get to know about the potential techniques and actions to troubleshoot.<\/p>\n\n\n\n 3. <\/strong>Compliance management and risk-assessment in real-time: At a time when the healthcare industry is facing a flood of new regulations and acts like interoperability and No Surprises Act, AI can facilitate real-time auditing\/assessment of regulatory compliance with prompt notifications and details on the latest development.<\/p>\n\n\n\n
Policy Change and Compliance<\/strong><\/p>\n\n\n\n
Conclusion<\/strong>: The best and advanced use of AI varies from one company to another. But the picture is fast getting clearer on what AI can do for businesses today and for many years to come. Lower compliance costs, less time, money, and resources consumption, and fewer errors at the push of the button is what AI is set to bring to the table as we move ahead.<\/p>\n\n\n","protected":false},"excerpt":{"rendered":"