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Hospital Corridor
Starry Sky

Smart.Claim.ADT IQ

Smart.Claim.ADT IQ is a managed service that helps health insurance plans efficiently process paper-based claims submitted by hospitals and clinics. It leverages Amazon Intelligent Document Processing (IDP) and related AWS serverless products to capture, classify, extract, enrich, review and validate data from claim forms in a secure, scalable and compliant manner.

Go-to-Solution

Smart.Claim.ADT IQ empowers health insurers to automate and streamline the end-to-end processing of paper claim forms. By digitizing claims data and applying intelligent document processing, it enables faster, more accurate claims adjudication while reducing manual effort, errors and costs.

Doctors with Documents
Starry Sky

What we offer ?

Smart.Claim.ADT IQ is a managed service that optimizes automated intelligent processing of paper claim forms a managed service that optimizes ADT and CCD management using AI and AWS serverless technologies.

For Who ?

Health insurance plans receiving large volumes of paper claims from hospitals/clinics.

Smart.Claim.ADT IQ utilizes Amazon IDP to capture claims as images, classifying form type, extracting & validating data using Amazon Textract, Amazon Comprehend & custom AI/ML models, exporting enriched claims data to adjudication systems. The serverless products support the organizations to capture, classify, extract, and enrich clinical and administrative data, ensuring compliance with the Well-Architected Framework.

How do we Leverage AWS ?

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Financial Benefits

  • Lower administrative and labor costs for claims operations

  • Reduced payment of erroneous claims

  • Faster revenue cycles and improved cash flows

  • Higher profitability due to operational efficiencies

  • Ability to redeploy staff to higher-value activities

  • No upfront capital investments due to pay-as-you-go pricing

  • Predictable operating costs that align with actual claims volumes

Operational Benefits

  • Improved data accuracy by reducing manual keying errors

  • Faster claims processing cycle times

  • Increased auto-adjudication rates

  • Enhanced provider and member satisfaction due to quicker reimbursements

  • Ability to handle spikes in claims volume with auto-scaling

  • Greater employee productivity by eliminating tedious data entry

  • Detailed audit trail of all claims processing activities

Benefits of the Cloud Adoption Framework

By aligning with the AWS Cloud Adoption Framework, Smart.Claim.ADT IQ delivers a comprehensive set of benefits across multiple perspectives, enabling health plans to transform their claims operations and achieve their business objectives more effectively.

Business Perspective

  • Accelerated claims processing: Smart.Claim.ADT IQ enables faster claims adjudication, reducing the time from submission to reimbursement. This improves provider satisfaction and member experience.

  • Improved accuracy: By automating data extraction and validation, Smart.Claim.ADT IQ minimizes manual errors, ensuring more accurate claims processing and reducing the risk of costly mistakes.

  • Scalability and flexibility: The solution can easily scale up or down based on claims volume, allowing health plans to adapt to changing business needs without the constraints of fixed infrastructure.

  • Competitive advantage: By leveraging advanced technologies and automating claims processing, health plans can differentiate themselves in the market and attract more providers and members.

People Perspective

  • Enhanced productivity: Smart.Claim.ADT IQ frees employees from mundane data entry tasks, allowing them to focus on higher-value activities such as complex claims review and provider relations.

  • Skills development: Working with the latest cloud technologies and intelligent document processing tools helps employees develop new skills and stay current in their field.

  • Improved job satisfaction: Automating repetitive tasks reduces employee frustration and burnout, leading to higher job satisfaction and lower turnover.

Governance Perspective

  • Compliance and security: Smart.Claim.ADT IQ leverages AWS's robust security controls and compliance certifications (e.g., HIPAA, HITRUST) to protect sensitive claims data and meet regulatory requirements.

  • Audit and control: The solution maintains detailed audit trails of all claims processing activities, enabling health plans to demonstrate compliance and investigate any issues.

  • Standardization: By centralizing claims processing on the AWS cloud, health plans can enforce consistent policies and procedures across the organization.

Platform Perspective

  • Serverless architecture: Smart.Claim.ADT IQ utilizes AWS serverless components like Lambda and S3, eliminating the need to manage underlying infrastructure and enabling automatic scaling.

  • Integration and interoperability: The solution can easily integrate with existing claims adjudication systems and other healthcare IT platforms using AWS's extensive API and connectivity options.

  • Future-proofing: Building on the AWS cloud allows health plans to easily adopt new technologies and services as they become available, ensuring the solution remains current and competitive.

Security Perspective

  • Data protection: Smart.Claim.ADT IQ encrypts claims data at rest and in transit using AWS KMS and SSL/TLS, safeguarding sensitive information from unauthorized access.

  • Access control: AWS IAM and Cognito enable fine-grained access controls, ensuring that only authorized users can view or modify claims data based on their roles and permissions.

  • Threat detection: Services like AWS GuardDuty and Security Hub continuously monitor for potential security threats and anomalies, providing proactive alerts and recommendations.

Operation Perspective

  • Simplified IT operations: As a fully managed service, Smart.Claim.ADT IQ reduces the operational burden on IT staff, freeing them to focus on more strategic initiatives.

  • Proactive monitoring: AWS CloudWatch and other monitoring tools provide real-time visibility into system performance and usage, enabling proactive issue detection and resolution.

  • Disaster recovery: By leveraging AWS's global infrastructure and built-in redundancy, Smart.Claim.ADT IQ ensures high availability and fast recovery in the event of any disruptions.

Leveraging AWS Well-Architected Framework

By leveraging these AWS products and services, Smart.Claim.ADT IQ can build a robust, secure, and cost-effective serverless architecture that aligns with the best practices of the AWS Well-Architected Framework. This ensures that the solution is optimized for operational excellence, security, reliability, performance efficiency, and cost optimization, delivering maximum value to healthcare organizations.

AWS products that can be integrated into Smart.Claim.ADT IQ, a healthcare solution for managing the claims process, including capturing, classifying, extracting, and enriching data from claim forms. These products enhance Smart.Claim.ADT IQ's capabilities in extracting insights and understanding unstructured healthcare data:

  • Amazon Textract: Extracts text, handwriting, and structured data from scanned claim forms, enabling accurate data capture and reducing manual data entry.

  • Amazon Comprehend Medical: Extracts insights and relationships from unstructured medical text within claim forms using natural language processing (NLP) and machine learning. This helps in understanding the context and identifying key information required for claims processing.

  • Amazon Rekognition: Analyzes and extracts information from medical images or supporting documents attached to the claim forms, such as itemized bills or medical records.

  • Amazon Transcribe Medical: Converts speech-to-text for any audio recordings associated with the claims process, such as voice notes from healthcare providers or recorded calls with insurance representatives.

The Core

Operational Excellence Pillar

  • Amazon CloudWatch: Monitors applications, responds to system-wide performance changes, and provides a unified view of operational health.

  • AWS CloudTrail: Enables governance, compliance, and operational and risk auditing of your AWS account.

  • Amazon EventBridge: Serverless event bus that makes it easy to connect applications using data from your own applications, SaaS, and AWS services.

  • AWS Step Functions: Coordinates multiple AWS services into serverless workflows to build and update apps quickly.

  • AWS Key Management Service (KMS): Makes it easy to create and manage cryptographic keys and control their use across a wide range of AWS services.

  • Amazon Cognito: Provides authentication, authorization, and user management for web and mobile apps.

  • AWS Identity and Access Management (IAM): Securely controls access to AWS services and resources.

  • AWS Secrets Manager: Protects secrets needed to access your applications, services, and IT resources.

  • Amazon GuardDuty: Continuously monitors for malicious activity and unauthorized behavior to protect your AWS accounts, workloads, and data stored in Amazon S3.

Security Pillar

Reliability Pillar

  • AWS Lambda: Runs code without provisioning or managing servers, providing high availability and fault tolerance.

  • Amazon S3: Offers industry-leading scalability, data availability, security, and performance for object storage.

  • Amazon DynamoDB: Provides a fast, flexible, and fully managed NoSQL database service for high performance at any scale.

  • AWS SDKs: Include tools and libraries that enable you to use AWS services with your preferred development language or platform.

  • Amazon S3 Transfer Acceleration: Enables fast, easy, and secure transfers of files over long distances between your client and an S3 bucket.

  • Amazon Textract: Automatically extracts text, handwriting, and structured data from scanned documents using machine learning.

  • Amazon Comprehend Medical: Uses natural language processing (NLP) to extract health data from unstructured text.

  • Amazon SageMaker: Builds, trains, and deploys machine learning models quickly and easily.

  • AWS Auto Scaling: Monitors your applications and automatically adjusts capacity to maintain steady, predictable performance at the lowest possible cost.

Performance Efficiency Pillar

Cost Optimization
Pillar

  • Amazon S3 Intelligent Tiering: Automatically moves data to the most cost-effective access tier based on usage patterns, without performance impact or operational overhead.

  • AWS Lambda: Provides a consumption-based pricing model, so you only pay for the compute time you consume.

  • Amazon CloudWatch: Delivers a unified view of operational health and enables you to set alarms, automate actions, and drive insights to optimize your environment and reduce costs.

  • AWS Budgets: Enables you to set custom budgets that alert you when your costs or usage exceed (or are forecasted to exceed) your budgeted amount.

  • AWS Lambda: Promotes sustainability by efficiently allocating compute resources and reducing energy consumption.

  • Amazon S3: Stores data in shared, multi-tenant hardware, optimizing resource utilization.

  • Amazon DynamoDB: Provides a serverless database that automatically scales capacity, minimizing over-provisioning and reducing energy waste.

  • AWS Customer Carbon Footprint Tool: Helps measure, track, and reduce the carbon emissions associated with using AWS services.

  • Implement efficient data storage practices, such as using Amazon S3 Intelligent-Tiering, which automatically moves data between access tiers based on usage patterns, optimizing storage costs and reducing the storage footprint.

  • Take advantage of AWS's commitment to renewable energy by running Smart.Claim.ADT IQ on AWS regions that have a higher percentage of renewable energy mix.

Sustainability Pillar

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