Our Products

According to the US National Association of Insurance Commissioners, there are approximately 900 health insurance companies in the US alone. The US processes approx. 1 Billion claims every year with 3 Billion transactions per year (e.g. eligibility and benefit verification, prior authorization and referral certification, and claim status inquiries). The statistics are similarly large across other countries, including Germany, and India. Today, Artificial intelligence provides amazing opportunities to transform healthcare operations both for payers and providers of care to deliver better clinical outcomes and improved patient satisfaction.

With this aim, and backed by a AI powered toolset of advanced analytics, and a technology stack that has been training on multiple thousands of claim records and procedures, our proprietary products and real-time managed services offerings will help you vastly improve efficiency and efficacy of critical areas of population health analytics, care delivery and health insurance core operations (e.g. claims processing, case management and appropriate care coordination). Using our products and managed services model, your organization can realize 3% - 15% operating margin expansion while improving patient satisfaction and retention. Our offerings can help health insurers and Third Party Administrators (TPAs) to improve the efficiency and efficacy of their data backed health interventions. We have built a strong portfolio of 10 healthcare offerings including (each of these to be a hyperlink to lead to a new page with specific content of that area – the wireframe and template can be same across all 10 offerings)

Our 10 Exclusive Offerings

Population Health real time visualization

Using your claims and underwriting data, an insurer can get a real time AI backed view of population health dynamics by city, by patient cohort, by type of condition, by claimant, non-claimant, high value / low value, inpatient / outpatient claimants. This real time enterprise level visualization will completely redefine how your enterprise across sales, service, CXO level management interacts with and reorients itself from a patient centricity and insights points.

Claim Management

Claims approval and repudiation decisions. At approval, amount payable and billed vs. approved amount guidance based on patient’s claim file across all clinical, commercial, provider, therapeutic are considerations based on automated decisions

Case management and utilization management

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Stratifying care coordination

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Clinical Documentation

Natural language processing (NLP) can identify clinical indicators across a patient’s entire electronic medical record, including lab results, notes and prescriptions. NLP unlocks this unstructured (free form) data to understand each case and identify those where information may be missing. The result is more complete and accurate documentation to support better coding and appropriate quality measures.

Payment Integrity

Payment integrity is all about ensuring payments made from one organization to another are done correctly and appropriately. Data analysis and predictive modeling identifies problem areas and improper claims faster and more accurately than ever before.

Prior Authorization

Physicians have all relevant prior authorization information, insurance coverage, formulary rules and potential drug-to-drug interactions in real time. This gets patients their medicines faster and with less uncertainty when they get to the pharmacy counter

Disease identification and management pathways

Predictive models using regression techniques and newer machine learning approaches are helping in the early identification and preventative treatment of specific conditions. As an example, current models can identify signals of dementia five to eight years earlier than the first diagnosis.

Simplified Population Analysis

Advanced analytics can be presented in a graphical or pictorial format helping quickly define and profile populations, simplifying and speeding time to analysis and evidence generation to lower risk and improve outcomes.

Care Coordination

With intuitive, configurable workflow designs, providers get the information critical to coordinating care, including key patient identifiers, gaps in care, and complications with chronic and complex populations.