Automates patient registration and verifies demographics and insurance coverage using advanced NLP, OCR, and API integrations.
⚡ Technology:
NLP, OCR, Bedrock Data Automation, Amazon Textract
Performs real-time insurance eligibility checks, validates benefits and authorization requirements using API calls to payers and ML for insurance rules mapping.
⚡ Technology:
Real-time payer APIs, ML insurance rules mapping
Converts clinical documentation into accurate CPT/ICD codes and ensures coding compliance using advanced NLP and supervised ML for coding prediction.
⚡ Technology:
NLP clinical analysis, supervised ML, Amazon Comprehend Medical
Performs comprehensive pre-submission claim validation using rules-based and anomaly detection ML to detect common denial triggers.
⚡ Technology:
Rules-based validation, anomaly detection ML
Automates claim formatting and submission to payers via EDI, tracks acknowledgments, and ensures proper coding and documentation.
⚡ Technology:
EDI format conversion, multi-payer routing, B2B Data Interchange
Automatically matches ERAs with patient accounts, reconciles payments, and identifies discrepancies using document parsing and reconciliation algorithms.
⚡ Technology:
ERA processing, intelligent matching algorithms, reconciliation
Analyzes denial codes, categorizes denial reasons using classification models and predictive analytics. Identifies patterns and suggests corrective actions.
⚡ Technology:
Classification models, predictive analytics, pattern recognition
Provides comprehensive dashboards and tracks KPIs including payer performance, days in A/R, and revenue metrics using BI integration and time series forecasting.
⚡ Technology:
BI integration, time series forecasting, predictive analytics