CLAIMS MANAGEMENT
Our AI solution can resolve up to 80% of your claims processing problems and inquiries.
Activity Tracker
Audit Trail
Auto Triaging / Deep Learning
Block Claims Based on Provider, CPT, etc.
Block User
Check Run and Stop Loss
Idle Time and Break Tracking
Inventory Management
KPI-based Dashboards
Optimized Workflow
Production Forecasting
Production Planning and Control
Real-time Notifications
Real-time Query Resolution / SME Support
Target Management
Training Need Analysis
User Management
Work Distribution
Claims Management
Unlock access to key claims management features designed to reduce administrative tasks and speed up processing through inventory tracking, auto task assignment, KPI monitoring, streamlined production planning, comprehensive KPI dashboard insights, and more.
Activity Tracker
InsightPro helps you elevate resource management with an integrated activity tracker, offering supervisors and managers unprecedented insights into team performance and resource allocation.
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Activity Tracker
This dynamic tool centralizes resource information, eliminating the need to gather data from multiple sources, to facilitate quicker decision-making and optimized outcomes. Users have access to individual and team performances based on a comprehensive overview of tasks performed. This enables data-driven performance improvement strategies, paving the way for greater efficiency.
Audit Trail
InsightPro comprehensively tracks, records, and reports every facet associated with a specific workflow or business process.
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Audit Trail
Users get insights into participants, actions, timestamps, locations, and transaction methods in order to ensure transparency and accountability. This multifaceted tool also verifies task execution adherence and supports regulatory audits to validate compliance with established standards. For new employees, audit trails visually demonstrate the correct execution of processes, aiding training by showcasing real-world task execution.
Auto Triaging / Deep Learning
InsightPro integrates a deep learning-driven auto triaging process that streamlines received inventory and the prioritization of incoming tasks. When deployed within regulatory frameworks, users can expect to experience optimized efficiency while still maintaining compliance and accuracy. Image classification analyzes photos with AI-based Deep Learning models that identify and recognize various criteria—from image contents to the time of day.
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Auto Triaging / Deep Learning
- Pre-Processing (Prepare) – All data undergoes preparation to improve its quality and suitability. The pre-processing step eliminates undesirable elements and enhances essential aspects of images, making them more compatible with AI processing. Tasks include – duplication removal, irrelevant data trim, filter of outliers, the identification of missing data, and the correction of structural errors.
- Object Detection (Locating) – This stage involves the crucial task of pinpointing objects within images, achieved through image segmentation and determining object locations.
- Object Recognition and Training (Labeling) – Deep Learning algorithms delve into images in this phase, extracting patterns and distinctive attributes associated with specific labels.
- Object Classification (Applied) – This marks the peak of the process. At this stage, you’ve constructed an AI model capable of categorizing images based on various criteria and patterns learned from the training data.
- Connecting Workflow (Integration) – You are now ready to integrate your image-classifying AI model into an AI workflow. This connection involves specifying the input source, where new data is obtained, and the corresponding output, which determines the actions taken once the data is classified.
- Feedback Loop (Retraining) – To sustain effectiveness and relevance over time, the last step is to create a cyclical feedback loop that regularly collects operational process insights and incorporates them into the model’s learning process.
Block Claims Based on Provider, CPT, etc.
Users can handle similar claims in a batch rather than individually which optimizes the process flow and minimizes the time spent on repetitive tasks. When you apply consistent evaluations and checks to related claims, it ensures uniformity and reduces errors that could arise from disjointed processing. This leads to increased productivity and higher accuracy rate/better quality.
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Block Claims
Users can handle similar claims in a batch rather than individually which optimizes the process flow and minimizes the time spent on repetitive tasks. When you apply consistent evaluations and checks to related claims, it ensures uniformity and reduces errors that could arise from disjointed processing. This leads to increased productivity and higher accuracy rate/better quality.
Block User
InsightPro enhances error control and accountability by temporarily blocking users and restricting claims processing when predefined error thresholds are exceeded.
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Block User
Users can fine-tune this threshold to align with specific quality control standards, ensuring that claims with excessive errors are intercepted for rectification before further processing.
This ensures data accuracy, quality, and proactive error management, ultimately contributing to smoother operations and enhanced claims accuracy.
Check Run and Stop Loss
InsightPro enhances your processing efficiencies with this innovative, dual-action feature.
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Check Run and Stop Loss
The Stop Loss functionality prioritizes work distribution to examiners while the Check Run holds the define groups for distribution and releases accordingly. Together, these features optimize operations and ensure effective work allocation. Now examiners can focus on high-priority tasks, maximizing process efficiency and ultimately contributing to streamlined workflows.
Idle Time and Break Tracking
InsightPro leverages meticulous time allocation monitoring to provide insights and recommendations into your workforce’s time management.
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Idle Time and Break Tracking
This tool allows users to effortlessly categorize tasks as productive or non-productive activities, monitoring time disruptions and resource utilization. Based on these findings, tailor-made suggestions for refining time management practices are provided in order to enhance efficiency and achieve organizational success through improved productivity.
Inventory Management
InsightPro optimizes inventory management using real-time tracking, aging analysis, and capacity utilization monitoring to enhance resource efficiency, improve turnaround times and streamline operations.
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Inventory Management
Inventory gets automatically tracked across its entire lifestyle, spanning from creation to disposition. Managers can then categorize ongoing tasks into age brackets like 15+ or 30+ days, identifying potential roadblocks, facilitating reallocation of volume, and ensuring tasks remain on track. These insights uncover performance patterns and trends, aiding users with better strategic decision-making capabilities.
KPI-based Dashboards
InsightPro leverages the power of integrated dashboards and analytics to give users real-time access to process insights, helping to identify and address areas requiring swift attention.
These actionable dashboards elevate operational excellence by delivering heightened visibility and control to enhance operations management, enabling proactive decision-making, optimizing performance, and adhering to SLA standards.
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KPI-based Dashboards
These actionable dashboards elevate operational excellence by delivering heightened visibility and control to enhance operations management, enabling proactive decision-making, optimizing performance, and adhering to SLA standards.
- Executive Dashboards – Drive process efficiency, streamline operations, identify trends, and enhance overall performance through the insightful assessment of inventory, production, productivity, and accuracy reports.
- Supervisor Dashboards – Pinpoint over or under-utilized individuals and teams in order to make adjustments for balancing workloads, addressing staffing concerns, and optimizing resources.
- Personal Examiner Dashboards – Examine personal performance with insights pinpointing productivity and focus influencers that identify supportive and hindering aspects of practical work. Act upon suggestions for improvement in quality and accuracy of work.
- Manager Insights (Team Productivity) Dashboards – Acquire insights into monthly productivity fluctuations among teams across diverse locations or processes, enabling optimized resource allocation and enhanced performance management.
- InsightPro AI Assistant Efficiency Dashboards – Measuring the effectiveness of AI expertise in answering queries accurately and finalizing the queries sent to SMEs for resolution.
- Process KPI Dashboards – Display health of processes and highlight outliers related to key KPIs – TAT, productivity, accuracy, volume, etc. This streamlines intricate decisions through prompt data analysis, effortlessly allowing users to oversee and improve process health with ease, strengthen forecasting and process management capabilities.
- Productivity Dashboards – Get insights on the productivity trend for all your resources. This helps you manage the workload of teams, identifying the training and ramp-up plan needed for individuals and teams.
Optimized Workflow
InsightPro conducts a systematic analysis of your current workflow to identify bottlenecks, redundancies, and areas for improvement.
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Optimized Workflow
Then manual and error-prone tasks are automated, establishing KPIs to quantify the workflow’s effectiveness. This seamless integration of enhancements fosters continual improvement through user input and vigilant monitoring, ensuring sustained adaptability amid evolving circumstances in the healthcare industry.
Production Forecasting
InsightPro offers real-time insights, forecasting, and streamlined dashboards for enhanced production planning and informed decision-making.
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Production Forecasting
This tool tracks key metrics like pending volume, target completion time, and resource utilization to help teams and managers meet their demands and clear backlogs within their service level agreements (SLAs). This approach ensures the prompt handling of workloads and prevents the potential costs linked to SLA non-compliance and regulatory commitments.
Production Planning and Control
InsightPro transforms production planning and control by utilizing data-driven strategies to optimize operations, prevent SLA and regulatory violations, and enhance process efficiency.
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Production Planning and Control
It employs accurate forecasting, streamlined work distribution, workflow automation, and meticulous capacity planning to ensure seamless resource utilization and elevate delivery outcomes. By assessing processes through various KPI parameters and ranking them based on importance, users can make timely delivery decisions based on recommendations and forecasts for resource, volume, and time impacts. It also automates work distribution tasks based on process requirements and resource capabilities, tracking resource skillsets and uncovering capacity utilization for efficient demand fulfillment.
Real-time Notifications
InsightPro is revolutionizing operations through real-time notifications and automated alerts backed by advanced machine learning techniques and impactful indicators.
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Real-time Notifications
KPI-based thresholds are set in place to notify of any potential errors, prompting immediate action and ensuring superior data quality. This transformative approach enhances visibility and control for users, leading to effective operations management that drives lasting success.
Real-time Query Resolution / SME Support
Our Virtual InsightPro Assistant elevates your support capabilities through the use of real-time AI-powered solutions.
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Real-time Query Resolution / SME Support
This dynamic assistant combines natural language-based AI with Machine Learning to provide prompt answers, replicating human conversational patterns to engage users naturally. By pairing its extensive knowledge base with a collaborative approach with human subject matter experts (SMEs) when needed, the Virtual InsightPro Assistant provides optimal query resolution. This ensures the delivery of accurate and efficient user interactions.
Target Management
Optimizes productivity goals with a holistic approach to target allocation. Users are ensured alignment with business objectives while also upholding ethical standards.
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Target Management
Our data-driven precision provides customized efficiency and tailored productivity goals to optimize resource-specific targets and enhance operational effectiveness.
Training Need Analysis
InsightPro leverages machine learning and advanced outlier detection to pinpoint resources requiring additional training by analyzing performance, quality, and productivity data.
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Training Need Analysis
Our dynamic ramp-up plans adapt weekly or monthly, enhancing training effectiveness with ongoing benchmark updates. Using these in-depth analytics to assess trainee performance pre and post-training, users are provided with valuable insights for data-driven evaluation of training program efficacy.
User Management
InsightPro empowers managers and supervisors with streamlined control to elevate administrative efficiency.
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User Management
This robust tool eliminates the need for change requests and manual adjustments by providing configurable user and group settings, allowing for seamless group establishment, user assignment, and precise access to privilege control. Users gain effortless configuration control, simplified group management, and hassle-free user assignment, ensuring that team structures and access permissions remain aligned with evolving operational requirements. This leads to increased security and efficiency.
Work Distribution
InsightPro encompasses two work distribution approaches to enhance flexibility and efficiency, catering to various work types and optimizing resource utilization.
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Work Distribution
After records/documents are ingested via API or Service into the Queue(s), there are two basic ways of distributing them:
- Manual Distribution Based on Resource
Users pick what they want to work on from any assigned work Queues. There are two variations, depending on whether the work is assigned to the OHB (Over Head Bin – a repository of documents/records) or to personal work Queues. - Automation Distribution Based on Rules
The work in the Queues can be allocated and intelligently assigned based on predefined rules using atomic distribution. Strategically group work based on LOB, Claim Type, Aging, TAT, Priority, Pending Inventory, and Errors – then assign work based on the user roles, expertise, and permissions of the resource(s).
