Industry challenges
File volume
Thousands of claims and reimbursement requests to process daily across multiple payers.
Prescription consistency
Do the billed medications and procedures match the physician's orders?
Insurance coverage
Verify patient eligibility, deductibles, and coverage levels before each procedure.
Document fraud
Detection of falsified prescriptions, upcoding, and billing inconsistencies.
Documents processed
- —Medical prescriptions and physician orders
- —CMS-1500 and UB-04 claims forms
- —Insurance cards and Explanation of Benefits (EOB)
- —Hospital invoices and itemized statements
- —Prior authorizations
- —Medical reports and clinical documentation
- —Patient intake and admission forms
- —Certificates of medical necessity
Automatic validations
- ✓Billed procedures and medications match physician orders
- ✓Prescribing physician NPI number verified against NPPES registry
- ✓Patient eligibility verified at date of service
- ✓Billed amount compliant with Medicare/Medicaid fee schedules
- ✓Date consistency between prescription, treatment, and claim
- ✓Patient identity verified across all documents
Measured results
85%
time saved
+25%
fraud detected
-45%
reimbursement delay