Medical Claims Management

Health care is a multi-trillion-dollar business in the United States. According to the U.S. Centers for Medicare & Medicaid Services, in 2018 U.S. health care spending reached $3.6 trillion, or $11,172 per person. That’s almost 18% of the entire nation’s Gross Domestic Product.

Even more staggering is the number of medical billing errors that occur each year in the United States. Experts say that between 30% and 80% of medical bills contain errors. Doctors and hospitals in the U.S. leave billions of dollars on the table each year due to poor billing practices, which significantly impacts patients. A study by NerdWallet found that medical debt is the single largest category of consumer debt in the USA. One in six Americans will have a medical bill turned over to a debt collection agency.

No one can afford to overpay due to claims processing errors. Healthcare claims processing is clearly an area that is ripe for improvement.

The true value of health insurance comes when it is time to pay the bills. Health insurers often fall far short of delivering a good customer experience to their subscribers. With the huge size of expenditures and crushing costs inflicted on patients, even a small, incremental improvement in claims processing could result in hundreds of millions of dollars in savings for all involved.

Recent advancements in the application of AI and Machine Learning technology have led to a new breed of OCR software called Cognitive Capture that can radically improve the final mile, those hard-to-solve scenarios that ruin automation. In this book, we look at these specific challenges and then address how Cognitive Capture Software (CCS) overcomes these challenges.