Accurate claim records can positively impact reserve requirements/loss ratio. This leads to premiums that are more reflective of a payer’s actual experience, rather than a conservative estimate. Knowledge of claims history is powerful information when it comes to negotiating/pricing fair and competitive insurance premiums.
Press Ganey is a leading provider of patient experience measurement & performance analytics. They conduct a variety of patient experience surveys in hospitals and collect feedback to analyze every dimension of the patient experience. Healthcare providers are then provided a rating (on a five-point scale), based on the feedback. While it may be relatively easy to analyze the structured ratings provided in the feedback, additional effort is required for the analysis of unstructured comments. Reading all the comments in every section of each feedback form is humanly impossible.
In 2017, our client, a healthcare payer based in Pennsylvania, signed a five-year Bi-directional Data Exchange agreement with a health insurance provider as a part of the Population Health Management and Value-based Contract strategy. This enabled them to marshal resources from both organizations: EMR Data (produced by our client); Insurance Claims Data (produced by the insurance provider).
The chargemaster or charge description master (CDM) is a comprehensive listing of items billable to a hospital patient or a patient’s health insurance provider. It contains data elements such as charge descriptions, billing codes, pricing, and many other necessary data elements.
Overpayment on healthcare claims can cost millions of dollars. Our client, a payment integrity organization based in Indiana, offers post-payment claim overpayment & recovery solutions. They partner up with their customers to identify, eliminate and recover overpayments. They also qualify specific overpayment errors to determine the root cause, with a focus on situations that can be changed or eliminated.
Information retrieval is difficult because it can come in multiple different forms. It can come in the form of voice, text, and images. It can also come from implicit searches.
A healthcare provider based in Pennsylvania is using our data lake solution with image processing capabilities. The solution is helping them extract metadata and pixel information from echocardiogram (ECG) images (DICOM) stored across fragmented data storages, making them available for search and analysis. The solution has enabled real-time access to patient demographic data, textual information, measurement values, and DICOM image data.
A healthcare payer based in Indiana wanted an innovative solution using the tenets of Artificial Intelligence to extract information from thousands of PDFs of hospital charts and medical reports. The solution is helping them flag symptoms, diseases, and medical conditions that are shared with physicians to facilitate closer engagement with patients for any possible oversight.