DigiNurse™
Reduce the paperwork and handle claims faster
Reduce the paperwork and handle claims faster
Medical records and associated codes are getting more and more complex and changing faster every year. And this, of course, complicates insurance claims and supporting documentation that is filed for review by Insurance Carriers who are under pressure to deliver approval and payment yesterday. Because of the expertise regarding to discern a claim’s validity and the demand for highly-accurate review before payment approval, skilled labor is a necessity.
Nurses and various skilled labor that have extensive healthcare education and experience are needed to help Insurance Companies meet their claim processing needs, but adding more skilled labor is costly to try and meet the short turn-around times. Many systems on the market today try to provide fully automate these problems and others with high-tech solutions, but they often still fall short. That’s why the answer is not to replace our beloved nurses and health care professionals, but to aid them through computer-assisting technology.
There are a number of bottlenecks slowing down the review process. Like tracking down the key information needed to make an informed decision. But because HCPs and hospitals provide their documentation in various formats, this is no quick task for a nurse reviewing the facts of a claim. The lab results might be found on page 2 or page 11 of the information packet, or it might be missing altogether and must be requested before the claim can be approved. Or consider how even employee turn-over can delay the work because of needed training, especially if the there is no way to tell which claims are difficult to process and which are not.
Megaputer developed an automated solution for extracting out the essential information for helping claim review analysts or nurses process claims faster and more accurately. The solution uses advanced text analysis and pattern recognition techniques to find important document fragments and organizing it into an interactive claim review report.
DigiNurse™ automates the process of extracting clinical findings from patient’s medical records. The system uses a combination of NLP and AI (deep learning) approaches to perform accurate extraction clinical findings. DigiNurse can automate and reduce the work of hundreds of nurses, thereby managing costs and raising the standard for the company’s ability to pay out claims fast.
Once all the targeted information is extracted and organized, it then is run through logical evaluations of the presence or lack of detail provided for each quality check the nurse needs to review. Missing important information is then brought to the surface for clear attention so that the request for specific additional information can be relayed back to the HCP. Knowing the overall level of detail for a claim also helps the system to direct detailed and easier to process claims to newer staff and less documented claims to managerial staff for handling or training purposes.
DigiNurse also shows the Claims Reviewer where in the context of the documentation the key pieces of information exist with colored highlighting of the linguistic patterns. The transparency provided supplies the confidence in the results of the system as well as the on-the-job training.
DigiNurse takes medical records, claims, and supporting documentation in its various formats that HCP’s use and converts it into a standardized interactive claims review report. This report can then be leveraged by Claims Review Analysts or Nurses to more quickly and accurately process claims. Not only that, but DigiNurse also helps onboard new staff with its ability to notify managers of difficult claims or automatically route them to more experienced staff. Contact us to see DigiNurse in action.