MEDICAL AUTO-ENCODER- (MAE)

The Claim Xchange proprietary algorithm utilizes advanced technology to extract a range of medical information from discharge summaries, such as primary diagnoses, diseases, conditions, surgical and radiological procedures, medications, and negated conditions. These extracted medical entities are then linked to SNOMED and ICD10-CM codes to accurately depict a patient's clinical journey from admission to discharge. This process aims to ensure precise representation for medical billing and insurance purposes, leading to:

• Improved capture of all procedures for accurate adjudications
• Decreased hospital queries, resulting in faster processing times
• Reduction of tabulation and adjudication payroll costs by 25% to 40%

MAE leverages cutting-edge Natural Language Processing (NLP) and Natural Language Understanding (NLU) technologies, in addition to custom language models tailored for Indian medical terminologies.

DIGITIZATION OF BILL SUMMARY-

Claim Xchange empowers payers to digitalize incoming bills by employing a multi-class text-based Machine Learning algorithm that achieves over 95% extraction accuracy when classifying and mapping extracted line items. This product stands out due to its innovative design rooted in a first principles approach. It is easily scalable to accommodate thousands of hospitals and maintains a consistent master column mapping across various desired columns regardless of the hospital's format. The resulting output format is user-friendly, facilitating the automatic application of policy and medical adjudication rules, thus advancing the industry towards the automation of insurance claims adjudication.

Key advantages provided by the system include:

• A reduction of over 40% in tabulation and adjudication payroll costs
• Implementation of a guided QC framework leading to decreased QC time and effort
• Utilization of a highly accurate ML algorithm for mapping and NME classification
• Enhanced visibility into the cost of claims associated with providers and procedures
• Capability to methodically manage and optimize the provider network to lower the cost of care

INDEXATION & RECOGNITON OF DOCUMENTS-

Hospitals and payers exchange various documents throughout different stages of claims processing. The Claim Xchange engine identifies and categorizes different types of documents used in insurance submissions, including:

• KYC document recognition
• Claim FormDeclaration Form
• PAN card
• Summary Bill
• Detailed Bill
• Discharge Summary
• Lab Reports
• Radiology Report

Integrated with the Digital claims management platform, this engine notifies users proactively during document uploads about any missing documents, thereby minimizing round trips associated with missing information.