Everest Group IDP
             PEAK Matrix® 2022  
Indico Named as Major Contender and Star Performer in Everest Group's PEAK Matrix® for Intelligent Document Processing (IDP)
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Intelligent Automation for Healthcare Insurance Providers

Intelligent Document Processing and Intelligent Process Automation for Healthcare Insurance Providers

INDICO RESOURCE

Unlocking the value of unstructured data for financial services

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Health insurance automation key benefits:

  • Increase efficiency: Automate and accelerate tasks to capture profitable growth opportunities
  • Decrease cycle times up to 85%: Enhance internal and external stakeholder experience
  • Redeploy resources: Shift critical resources to higher-value opportunities
  • Reduce risk: Consistent, automated processes limit errors
  • Knowledge capture: Codifying processes turns individual know-how into institutional knowledge

Health insurance providers process millions of important patient documents annually, many of which require manual review in order to accurately assess what they say and any associated context. This kind of labor-intensive process naturally takes time, which means it involves a significant financial investment by the provider.

Part of the problem is a large percentage of documents in health insurance are unstructured or semi-structured. That puts them out of reach of solutions that rely on templates as well as health insurance robotic process automation (RPA) tools. Call it an example of “RPA fatigue.”

Yet automation in health insurance remains a business imperative if companies are going to meet their digital transformation goals.

Intelligent document processing provides a solution. An effective IDP platform can deliver success that far exceeds that of traditional artificial intelligence solutions.

Consider:
• Success rate of AI projects without the Indico Data Platform: 11%
• Success rate for Indico Data projects in production: 97%

The platform deploys on your private cloud or premises-based hardware – including on bare iron – thus eliminating entire categories of potential attack surfaces associated with third-party resources. And it is entirely self-contained, with no need to make calls to any outside services.

Indico never shares one customer’s data or models with another, so your proprietary data and intellectual property remain safe. Indico is HIPAA-compliant and has also achieved SOC 2 Compliance. SOC 2 is a designation by the American Institute of CPAs (AICPA) indicating the ability to manage customer data based on five “trust service principles” – security, availability, processing integrity, confidentiality and privacy.

Intelligent Document Processing and AI Use Cases in Health Insurance

Health insurance document automation solutions take advantage of artificial intelligence (AI) to improve productivity in numerous processes involving unstructured content, including the following.

Health insurance claims automation

Processing an individual claim can be a painstaking process. Say a hospital files a claim for services it renders, such as an MRI. Before paying the claim, the health insurer must go through the patient’s electronic health record (EHR) file, which may contain hundreds of pages, to find the doctor’s order for the MRI. The claim may also involve the actual MRI image, which would be far out of reach for an RPA tool to handle, but no problem for the Indico Unstructured Data Platform.


Long-term care invoices

Dealing with invoices for patients in long-term care can be especially demanding for health insurance companies because the stakes are high and there are numerous values to extract. Beyond the basics of name and dates of care, those details include hours, rates, and line items for each required service. Traditionally, agents must read the invoices and manually input relevant values into a downstream processing system, such as K2. Healthcare document processing models, combined with an RPA tool for data entry, can automate 85% or more of the process. In some instances, an IDP model can enable straight-through processing, such as for invoices pre-processed by a third-party provider like AssureCare.


Patient record processing

An IDP platform can also help health insurers deal with patient records. IDP models can be trained to ingest paper documents, images and digital records from hospital EHR systems. They can automate the process of sorting, identifying and matching paper documents, including faxed documents, to a patient’s EHR.


Claim denial documentation

When a health insurer denies a claim, it’s likely the matter will come up again from either the provider, patient, or both. When it does, it behooves the insurer to quickly assemble its supporting evidence for why the claim was denied. Intelligent document processing models can help in that effort, by finding relevant documents, extracting supporting evidence on why the claim was denied, and assembling it to expedite a response to the provider or patient.


Ingesting claims documents

Claims documents tend to arrive in large bundles containing numerous discreet documents that pertain to different claims. Employees spend hours going through these bundles and determining where each individual document belongs. A sound healthcare document processing model would be able to automate the process of sorting and categorizing the individual documents, and keeping associated documents together for further processing.


Automate document workflow

Intelligent document processing can help health insurance companies classify all sorts of documents, including patient and provider correspondence, clinical documentation and various kinds of reports. Healthcare document automation models can be trained to extract key data from each type of document, such as a patient date of birth, data of service, address, provider name, patient name, member ID numbers and more.


Patient correspondence

Processing thousands of pieces of correspondence from patients is another pain point for health insurers. IDP can help them read and classify this correspondence, whether it’s paper or email. Health insurance automation models can extract pertinent data such as the patient ID number and date of birth, and match it with other recent patient activity to help streamline a response.


Applying analytics to health insurance

Health insurers have a treasure trove of historical data at their disposal that can help drive better business decision-making. The problem is most of it is in trapped in historical claims records and other documents, the vast majority in an unstructured format. Intelligent healthcare automation models can help unlock that unstructured data and turn it into a structured format. Companies can then apply analytics tools to the now-structured data. That would enable them to identify trends in pricing ranges, for example, and adjust pricing accordingly – among numerous other potential uses.


The Indico Data Approach to Intelligent Document Processing

Part of the beauty of the Indico Unstructured Data Platform is it requires no specialized expertise to use. In fact, it’s intended to be used by those employees who know your processes best: the ones who perform them day-to-day. That’s right – employees build models to automate the tasks they do each day, without any help from IT or data scientists.

Behind the scenes, the Indico Data platform takes advantage of numerous artificial intelligence technologies, including natural language processing, machine learning and transfer learning. It’s also built on a database of some 500 million labeled data points, which is enough to give the platform context behind any type of unstructured document, image, audio or video file.

The platform’s intuitive user interface makes it easy for your employees to label the important types of data they want to extract from a document. It takes just a few hours to label enough documents to create a health insurance automation model that functions with better than 90% accuracy. (Click here to learn more about the Indico Data approach to intelligent document processing.)

Transparent AI: No Black Boxes

Perhaps you’ve come across AI solutions that make it difficult to determine how decisions are being made. In many cases, providers essentially say, “Give us your data. We’ll do our AI magic and send the results back to you.” (That “magic” may also involve help from off-shore coders.)

In such cases, there’s no visibility, transparency or control over how AI decisions are made. It’s just a black box.

The black box approach won’t fly in healthcare, not when you’ve got to comply with HIPAA and other regulations that require full transparency in terms of who can see what data and how decisions are made.

Indico Data provides that kind of transparency, with clear audit trails that detail exactly how every decision is made. What’s more, because your employees build the healthcare automation models that make decisions, it’s easy to uncover their intent.

An Analytical Approach to Process Optimization

The initial models you build with Indico Data are just a starting point. We provide tools that enable you to analyze your processes and optimize models over time.

The Indico Data platform provides analytics tools that expose how much time employees spend on each part of a process, highlighting any values that seem excessive – making them ripe for improvement.

It even helps you pinpoint which areas of a process to look at for improvements. Perhaps Document A goes straight through the automation software process nine times out of 10. We’ll point you to the one that failed, so you can home in on that and determine the reason why.

The Indico Unstructured Data Platform can also break down results by user. Perhaps John’s straight-through processing rate is down vs. other employees. We’ll provide analysis that shows which elements he’s spending the most time on, so you help gauge whether his time would be better spent elsewhere.

Highly Secure Architecture

Health insurance companies naturally need to ensure all their IT infrastructure and applications are highly secure. Indico Data understands that requirement and has built its platform accordingly.

The platform deploys on your private cloud or premises-based hardware – including on bare iron – thus eliminating entire categories of potential attack surfaces associated with third-party resources. And it is entirely self-contained, with no need to make calls to any outside services.

Indico never shares one customer’s data or models with another, so your proprietary data and intellectual property remain safe. Indico is HIPAA-compliant and has also achieved SOC 2 Compliance. SOC 2 is a designation by the American Institute of CPAs (AICPA) indicating the ability to manage customer data based on five “trust service principles” – security, availability, processing integrity, confidentiality and privacy.

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