Case studies Healthcare
Pre-authorisation checks that prevent denials for a healthcare provider
A healthcare provider
40%less manual review and resubmission effort
3%
Fewer pre-authorisation denials
FHIR/HL7
Connected to the health record and the clearinghouse
The challenge
The provider was losing revenue to preventable pre-authorisation denials. Coding errors, documentation gaps and complex payer requirements sent requests back for correction and resubmission.
What we built
- A pre-submission validation step that checks every pre-authorisation request before it reaches the payer.
- Automated coding, documentation and payer-policy checks, using a rules engine with OCR and intelligent document processing.
- Integration with the electronic health record and the clearinghouse through their APIs and FHIR/HL7.
The results
- Manual review and resubmission effort fell by 40%.
- Pre-authorisation denials fell by 3%.
- Cleaner submissions and faster reimbursement.
Related work.
40%reduction in case resolution time
An agentic customer service hub for a global pharmaceutical company
A global pharmaceutical company
82%of queries answered by the agent, with 90% accuracy
A knowledge agent for a specialised medical devices provider
A specialised medical devices provider
+2 ptscustomer satisfaction gain in the first six months
Voice-of-the-patient insights for a large US healthcare network
A US healthcare network with 27 hospitals across five states
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