Automated Claims Processing

Automate claims intake: classify claim documents, read CMS-1500, UB-04 and unstructured documents, validate and route, on your own servers.

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Automated claims processing

Claims arrive as a bundle of documents: claim forms, medical bills and records, police and adjuster reports, photos, invoices and correspondence. Automated claims processing captures them, identifies each document, reads the data the claim system needs, and routes the claim, so adjusters and billing staff spend their time on decisions instead of data entry.

What can be automated

  • Intake from mail, fax, email and portals into one queue.
  • Classification: splitting a claim packet into its documents and identifying each type; see document classification.
  • Extraction: claim and policy numbers, claimant details, dates of service, codes and amounts. Standard forms such as the CMS-1500 and UB-04 have fixed layouts that template OCR reads quickly; letters and reports need AI.
  • Validation against policy and member data, and routing of exceptions to a person.
  • Filing each document to the claim in your claims or document management system.

Claims processing with SimpleIndex

SimpleIndex combines zone OCR for standard claim forms with its optional AI for everything else, checks values against your database, and delivers documents and data to your claims system. It runs on your own servers, and so can its AI, so protected health and personal information stays inside your network; see HIPAA compliance. For high volumes with verification stations, ABBYY FlexiCapture is the enterprise option.

Send us a sample claim packet and we'll show you the results. Ask us or call 865-637-8986.

Related

Patient intake and document management  -  AI document processing  -  On-premise AI

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Tell us about your documents and workflow, and we will recommend the right software and set up a demo or quote.

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From our office in Knoxville, TN we provide on-site installation, training and demos across East Tennessee, including Knoxville, Oak Ridge, Maryville and Alcoa, Chattanooga and the Tri-Cities. Everywhere else, including Nashville, our online setup, training and support make on-site visits unnecessary for most projects.

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