Automating Claims Processing for a Leading Hospital in Bangalore, India
Key Outcomes
• End-to-End Claims Processing Automation: Eliminated manual intervention in key steps.
• 50% Reduction in Approval Time: Claims processing time reduced from 10 days to 5 days.
• Improved Accuracy: Reduced errors in claim submissions by 40%.
• Enhanced Patient Experience: Faster insurance approvals led to better patient care.
• Cost Savings: Saved an estimated ₹1.5 crore annually through reduced administrative overhead.
The Challenge: Inefcient and Manual Claims Processing
The hospital struggled with an inefcient insurance claims process that required extensive manual intervention. The key challenges included:
1. Manually submitting patient treatment requests to insurers.
2. Entering data into the hospital’s Electronic Health Records (EHR) system.
3. Verifying insurance details and policy coverage.
4. Ensuring compliance with medical necessity verication.
These steps led to delays in claims approval, increased operational costs, and a suboptimal patient experience. The hospital sought an AI-powered solution to streamline this workow.
AI-Powered Claims Processing Solution
Third Eye Social deployed three AI agents to automate the entire insurance claims workow:
1. Processing Agent: Automated data entry into the hospital’s EHR system, signicantly reducing errors and administrative workload.
2. Communication Agent: Interacted with insurance providers to verify coverage, eliminating the need for manual follow-ups.
3. Validation Agent: Ensured compliance by cross-checking patient treatment details with insurance policies to prevent claim rejections.
Implementation Details
• Deployment Time: The solution was implemented in 12 weeks—3 weeks for analysis, 6 weeks for development and testing, and 3 weeks for staff training.
• Integration with Existing Systems: The AI agents were designed to work seamlessly with the hospital’s EHR system, Oracle, and third-party insurance portals.
• Training & Adoption: Hospital staff received hands-on training, leading to a 95% adoption rate within the rst month.
Transformative Results
– End-to-End Automation: The claims process became fully automated, signicantly reducing manual intervention.
– 50% Faster Approvals: Claims approval time reduced from 10 days to 5 days, ensuring quicker patient treatment.
– 40% Fewer Errors: Improved accuracy in data entry and validation, reducing claim rejections. Enhanced Patient Experience: Faster processing meant less waiting time and quicker access to treatment.
– ₹1.5 Crore in Annual Savings: Reduced administrative costs and improved operational efciency.
Conclusion
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