Business Impacts
91.09%
document extraction accuracy (English & Italian)
10+
Mediclaim processing rules automated
95%+
accuracy in disease, diagnosis, and procedure classification
Customer Key Facts
- Region : Europe
- Industry : Commercial Insurance Broker
Overview
The client, one of the leading insurance brokers in the world, wanted to automate the medical claims process workflow with an end-to-end intelligent document processing (IDP) solution which can process medical claims by accurately extracting relevant data from a wide range of doument formats and comparing data across medical records, invoices and internal systems.
Challenges
- The manual reviews are slow and inefficient due to diverse document formats, necessitating system data comparison, Macro Guarantee and ICD mapping
- Absence of a user-freindly tool for reviewers to compare invoices and medical records and flag discrepencies in key details such as user names, invoice amounts, medical center
- Manually going through the documents of varying template and format to find the required data, makes this process is extremely error-prone
- High operational cost and lowered customer satisfaction
Solution
Dociphi, Quantiphi’s AI-powered intelligent document processing platform, transformed claims processing, by eliminating the need for the reviewer to manually process each and every claim document
- Dociphi seamlessly ingested and classified invoices and medical records, used proprietary best-in-class machine learning models to extract information from a wide range of document formats and templates, even from handwritten documents
- Dociphi's proprietory models intelligently mapped the Macro Guarantees and ICD codes to each claim submission based on extracted data from the documents such as diagnosis, medical test, body part, etc
- With Dociphi's smart comparison screens to compare the extracted data from docs with system data and highlight all the discrepancies, reviewers can close claims faster.
Results
- Creation of a comprehensive AI-driven claims processing workflow, that supports data extraction from complex tables & hierarchical data
- ML Powered ICD and Macro Guarantee mapping
- Improved claims handling efficiency for accelerated claims turnaround time
- Reduction of manual efforts for claim adjusters thereby reducing operational cost
- 91.09% accuracy achieved in document extraction for English and Italian records.
- 10+ Mediclaim processing rules automated through a domain-adapted AI model.
- 95%+ accuracy attained in disease classification, diagnosis identification, and procedure mapping using a model enriched
