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CliniAid | COVID-19 Claim Automation

CliniAid | COVID-19 Claim Automation

CliniAid | COVID-19 Claim Automation

By i3systems

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Overview



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Description

CliniAid: Approve COVID-19 discharge Claim in 30 Minutes

The COVID-19 pandemic has transformed the healthcare industry. Insurers are finding it difficult to process the COVID-19 claims on time resulting in delays in the discharge process. This has accelerated the need for intelligent automation solutions to reduce the overhead of claims adjudicators and ensure faster & accurate claims.

i3systems' CliniAId is an Intelligent Automation solution that enables insurers and TPAs to approve COVID-19 claims in 30 minutes by automating financial and medical adjudication. The solution is equipped with components to manage the overall claims process from accurate data ingestion to authorization and approval

Features of using CliniAid:

  • CliniAId helps in handling an unexpected increase in the number of claims by automating medical adjudication and being equipped to manage the end-to-end claims process.
  • CliniAid can extract medical data in claim documents to identify relevant details such as symptoms, diagnosis, treatment or procedures, medicines, etc. to help the medical officer check the medical admissibility of the case
  • Using CliniAId-coded medical data and clinical rules prepared by Claim officers, the system can automatically validate the claim to achieve auto-adjudication of certain claim types which substantially reduces the AHT.

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EHR integration

Integrations:

None provided

EMR Integration & Relevant Hardware:

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EMRs Supported:

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Hardware Compatibility:

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Clients

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Use cases

Description

Claim Automation for Covid-19 Cases

COVID-19 use cases:

Challenges:



  • Due to the uncertainty, COVID-19 claims are 3-times higher than average claims
  • COVID-19 claims need 70-100% more average handling time (AHT) than usual claims.
  • COVID-19 has overwhelmed the healthcare industry making it extremely difficult to manage customer expectations.
  • Huge variations in treatment depending on comorbid conditions, severity of the condition & cost.

Solution through CliniAid:



  • CliniAId helps in handling an unexpected increase in the number of claims by automating medical adjudication and being equipped to manage the end-to-end claims process.
  • Using CliniAId-coded medical data and clinical rules
  • prepared by Claim officers, the system can automatically validate the claim to achieve auto-adjudication of certain claim types which substantially reduces the AHT.
  • The solution is highly scalable and can accommodate a sudden rise in the number of claims with relative ease.
  • CliniAid can extract medical data in claim documents to identify relevant details such as symptoms, diagnosis, treatment or procedures, medicines, etc. to help the medical officer check the medical admissibility of the case.


Pediatric use cases:

Yes

Users:

Healthcare Insurance providers, Healthcare TPAs, BPOs / GSIs



Differentiators

Differentiators vs Internal Options:

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Differentiators vs Competitors:

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Company information

Founded in 2016

2.5M total equity funding

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0%
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3
0%
2
0%
1
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Reviewer’s Role
  • End user
  • Project manager
  • IT / Technical support
  • Executive sponsor
  • Internal consultant
  • Other

Reviewer’s Org Size
  • XL ($5B+ NPR)
  • L ($3-5B NPR)
  • M ($1-3B NPR)
  • S ($0.2-1B NPR)
  • XS (< $0.2B NPR)

Reviewer’s Org EMR compatibility

Reviewer’s Org Type
  • AMC
  • Pediatric Facilities
  • ACO
  • Rural Presence

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