AI-First Health Plan Operations

The following is a guest article by Deepan Vashi, Executive Vice President and Global Leader at Firstsource Practical AI Deployments can Enable Health Payers to Improve Efficiencies, Cut Costs, and Improve Stakeholder Experiences While media pundits speculate on the future of AI, for healthcare payers, AI can be a very practical tool enabling them to increase operational efficiency, cut administrative costs, and improve member experiences. The key to success with today’s AI capabilities is focusing on applications that deliver real returns. Today, that means tackling two of the industry’s biggest costs: claims processing and contact centers. Improving speed, accuracy, and service in those areas will create better provider and member experiences while containing costs. Here’s a look at where and how to get started with AI-first operations. AI-First Claims Management Payers struggle to pay claims on time, resulting in interest payments and penalties that ultimately increase healthcare costs. Accuracy is also an issue, with many payers spending resources recovering overpayments. Issues with claims lead to higher call volumes and increased contact center expenses. Auto adjudication rates are typically only about 80% to 85%, and every percentage point improvement in auto adjudication unlocks significant value. AI is ready to streamline the claims management process. Health plans are deploying decision agents, numerical and natural language data analyzers, and predictive ...
Source: EMR and HIPAA - Category: Information Technology Authors: Tags: Administration AI/Machine Learning C-Suite Leadership Health IT Company Healthcare IT Hospital - Health System Revenue Cycle Management AI Automation AI-First Claims Management Deepan Vashi Firstsource Health Plans LLM Source Type: blogs