Extract policy and claim information, compare it with coverage rules and prepare responses for appealable denials.
HealthcareAn insurance and healthcare-services provider handles high volumes of denied claims. Its claims operation needs specialised policy knowledge and must work across the tools already holding claim and coverage information.
Manual review consumes expert time on multi-step work. Staff must read the policy and claim, judge it against coverage rules and produce a compliant response before the case can progress.
Select a stage to see the records it uses, the action it takes and the result.
Claims staff spend less time extracting and comparing information across records.
The workflow carries the review into response preparation, reducing the separate handoff after identifying an appealable case.
An insurance and healthcare-services deployment reported a 70% reduction in manual denial-review time and faster resolution cycles.
The publication does not state the measurement period.
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