Reducing Claims Denials: AI-Driven Claims Processing for Healthcare Payor

Streamline claims processing with AI for healthcare payors! Minimize denials, enhance accuracy, and improve overall efficiency.

Challenges

  • The average denials rate was up 23% in the previous 3 years. Up to 65% of rejected claims were never resubmitted​
  • 20% claims either had missing mandatory information for payment or incorrect medical coding​
  • Claim Submissions overloaded with irrelevant attachments and dynamic complex layouts of document structure that resulted in SLA non-compliance​

Solution

Intelligent

Data Engineering to pre-process each case for intelligent document indexing, classification and OCR conversion​

Deep Learning​

Models to intelligently extract and interpret data from complex and varied layout documents​

3-way

among claims form, supporting documents and system records, to verify the submissions for duplicity, fraud and payment leakage​

Impact

20%

Denial Rate Reduction​

50%

Reduction in Average Claims Processing

50%

Efficacy gain with intelligent document processing

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The technology consistently delivered on its promises.

Earlier this year, I partnered with Zimetrics to integrate AI automation into our document review process for our car subscription service. I wholeheartedly endorse both Zimetrics, the Zimetrics team, and their top-tier tech. Our challenge was two-fold: 1. We needed AI to streamline our document processing for customer applications. 2. We wanted to enhance our digital customer experience. Zimetrics' 8Nap AI platform was the answer. The technology consistently delivered on its promises. The model training process, which often can be complex and intricate, was remarkably straightforward. The AI quickly adapted to the diverse documents we handle, maintaining high accuracy. Surprisingly, even with a modest set of example documents, we accomplished a thorough model training. The integration process was smooth, and the platform allowed for quick customizations to fit our specific needs, all while upholding strict security and compliance standards. Special credit goes to the Zimetrics team. Their expertise and professionalism shone through from day one. But it was their dedication to our needs that truly stood out. They ensured open communication, clear planning, and consistently met our timelines. In summary, I strongly recommend Zimetrics and their 8Nap AI platform. Their technology is impressive, and their team is a valuable partner to any business. I eagerly look forward to further incorporate their AI-powered automation technology into all our document-centric processes.

David Kaganovsky

Chief Technology Officer

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Genuine commitment to client success

Zimetrics consistently delivers outstanding customer service, combining responsiveness with a genuine commitment to client success. Their team is passionate about working with cutting-edge technologies and goes out of their way to support our software and teams. Within a relatively short period of working with them, we have been able to transition one of our functions completely to them.

Vaibhav Puranik

Sr. Vice President of Global Engineering

GumGum

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Big part of our success story

At Avation Medical, we truly value our partnership with Zimetrics. Their team brings a wealth of knowledge in all aspects of healthcare software including firmware, mobile apps, cloud data, DevOps and eCommerce, which greatly helped us with seamless integration. The team runs projects efficiently, independently and diligently, with clear understanding of business and patient needs. It has been my pleasure to work with Zimetrics, as they continue to be a big part of our success story.

Manish Vaishya

Chief Technology Officer

Avation Medical

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Professionalism and Expertise

Zimetrics has proven to be an excellent offshoring partner, providing us with skilled engineers from India. Their team's contributions have significantly enhanced our projects, and their professionalism and expertise have made collaboration seamless. We value our partnership with Zimetrics for the quality and reliability they bring to our extended team.

Ken Weiner

Chief Technology Officer

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A partner who I can rely on

I have worked with Zimetrics to develop several very complex, customer-facing solutions, and in the process I've learned what makes Zimetrics valuable and rather unique as a software service provider. Zimetrics strives to create very engaged engineering teams that really understand what my business needs including my customers. And they have all the software service categories to handle most any problem I've asked them to solve, including application development, real-time cloud telemetry, manufacturing systems and embedded diagnostics. With Zimetrics I have a partner who I can rely on to deliver, and who invests in my company's successes for the long-term.

Brent Goldstein

Vice President, R&D - Software & Additive Products

Fresh Health

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Deep Expertise, Complete Ownership, Specialized Consulting

Zimetrics played an instrumental role in a high-tech solution for us, involving diverse Big Data technologies with high-performance engineering and web-scale considerations. Besides everything else, what stood out was their breadth of expertise, their deep skill level, and a comprehensive consultative approach with a keen customer success focus.

Vice President, Engineering & RnD Division

A Global Consumer Electronics Major

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One word: Awesome!

Zimetrics partnered with us to build an analytics platform for our stealth mode startup, which aims to disrupt the call center industry. The experience of working with Zimetrics has been pure joy and the planning, timeliness, quality, thoughtfulness, cost and impeccable execution has put us on a very strong footing. I must also confess that it has been a personally very humbling experience for me, as before meeting the Zimetrics team, I used to consider myself to be an expert in Business Intelligence - Just Sign up!

Manish Panjiar

Founder & CEO

XTaaS Corporation

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