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Smart.Claim.Imaging IQ

Smart.Claim.Imaging IQ is a comprehensive managed service that leverages Amazon Intelligent Document Processing (IDP) and other AWS serverless products to streamline and automate the processing of paper-based claims submitted by imaging and radiology centers to health insurance companies. The service captures, classifies, extracts, enriches, reviews and validates data from claims, ensuring accurate and efficient processing while maintaining compliance with the AWS Well-Architected Framework.

Go-to-Solution

Smart.Claim.Imaging IQ is a game-changer for health insurance companies processing claims from imaging and radiology centers. Our managed service leverages cutting-edge AWS technologies to automate the capture, classification, extraction, enrichment, review, and validation of data from paper-based claims. We enable health insurers to process claims faster, more accurately, and at lower costs, all while maintaining strict compliance with industry standards. With Smart.Claim.Imaging IQ, health insurance companies can streamline their operations, reduce errors, and deliver better service to their customers.

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What we offer ?

Smart.Claim.Imaging IQ is a managed service that automates the processing of paper-based claims from imaging and radiology centers

For Who ?

The service is designed for health insurance companies looking to optimize their claims processing operations.

Smart.Claim.Imaging IQ uses Amazon IDP and AWS serverless products to capture, classify, extract, enrich, review, and validate data from claims, ensuring compliance with the Well-Architected Framework.

How do we Leverage AWS ?

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Financial Benefits

  • Reduced operational costs, labor and infrastructure expenses

  • Pay-per-use model, eliminating upfront investments

  • Reduced storage costs, minimizing physical storage requirements

  • Scalability cost savings, avoiding overprovisioning or underutilization

  • Minimized compliance costs, avoiding penalties and fines

  • Improved cash flow for healthcare providers

  • Reduced error-related costs, minimizing rework and appeals

  • Long-term cost savings through streamlined processes and efficiency

Operational Benefits

  • Streamlined processing, reducing manual effort and time

  • Improved accuracy, minimizing errors and ensuring data integrity

  • Increased efficiency, automating repetitive tasks

  • Seamless scalability, handling fluctuating workloads

  • Enhanced compliance, meeting industry standards and regulations

  • Improved customer service, faster reimbursements and fewer complaints

  • Optimized resource allocation, staff focusing on strategic tasks

Benefits of the Cloud Adoption Framework

By integrating Smart.Claim.Imaging IQ with the AWS Cloud Adoption Framework, organizations can realize a wide range of benefits across multiple perspectives. From improving business outcomes and empowering employees to ensuring governance and security, the combination of Smart.Claim.Imaging IQ and AWS services creates a comprehensive solution that drives digital transformation and optimization in the healthcare industry.

Business Perspective

  • Improved customer experience through faster and more accurate claims processing

  • Increased competitive advantage by optimizing operations and reducing costs

  • Enables data-driven decision making, leveraging insights from claims data

  • Enhances scalability to accommodate business growth and changing market demands

People Perspective

  • Empowers employees to focus on higher-value tasks, improving job satisfaction

  • Reduces manual and repetitive work, allowing staff to develop new skills

  • Fosters a culture of innovation and continuous improvement

  • Enables better collaboration and communication among teams

Governance Perspective

  • Ensures compliance with industry regulations and standards, such as HIPAA and GDPR

  • Provides a framework for data governance, ensuring data security and privacy

  • Enables better risk management and mitigation through automated processes

  • Allows for easier auditing and reporting, demonstrating compliance to stakeholders

Platform Perspective

  • Leverages AWS serverless products for a scalable, flexible, and cost-effective solution

  • Enables integration with existing systems and tools, creating a seamless workflow

  • Provides a foundation for future innovation and development of new services

  • Allows for easy deployment and management of the solution across the organization

Security Perspective

  • Incorporates robust security features from AWS, ensuring data protection and privacy

  • Enables secure access control and authentication through AWS Identity and Access Management (IAM)

  • Provides encryption of data at rest and in transit, using AWS Key Management Service (KMS)

  • Allows for continuous monitoring and threat detection, leveraging AWS security services

Operation Perspective

  • Streamlines claims processing operations, reducing manual effort and increasing efficiency

  • Enables proactive monitoring and management of the solution through AWS CloudWatch

  • Provides automated deployment and scaling, using AWS CloudFormation and Auto Scaling

  • Allows for easy troubleshooting and issue resolution, leveraging AWS support and documentation

Leveraging AWS Well-Architected Framework

By leveraging these AWS products and services, Smart.Claim.Imaging IQ can be architected to align with the AWS Well-Architected Framework pillars. This serverless architecture ensures the application is operationally excellent, secure, reliable, performant, and cost-effective. The combination of these services allows for a scalable, fault-tolerant, and efficient solution that meets the needs of the healthcare industry while optimizing costs and resources.

The core AWS products for digitizing imaging and radiology medical orders and the associated images in Smart.Imaging IQ include:

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  • Amazon Intelligent Document Processing (IDP) and Amazon Textract for extracting data from documents and forms.

  • Amazon Rekognition for analyzing medical images, Amazon S3 for durable and scalable storage of digitized orders and images,.

  • AWS Lambda for serverless computing and data processing.

  • Amazon DynamoDB for storing structured metadata and processing results.

  • Amazon API Gateway for creating secure APIs and integrating with other systems.

 

These products work together to efficiently digitize, process, store, and expose the data and functionality of Smart.Imaging IQ, enabling imaging and radiology centers to streamline their workflows, improve data accuracy, and enhance decision-making capabilities in a scalable and cost-effective manner.

The Core

Operational Excellence Pillar

  • Amazon CloudWatch: Monitors and logs metrics, sets alarms, and provides insights for optimizing the application.

  • AWS Lambda: Runs code without provisioning or managing servers, enabling serverless compute.

  • Amazon CloudTrail: Records AWS API calls and events for auditing, security monitoring, and operational troubleshooting.

  • AWS Config: Assesses, audits, and evaluates the configurations of AWS resources, ensuring compliance with organizational standards.

  • Amazon Cognito: Provides user authentication, authorization, and user management for secure access to the application.

  • AWS Identity and Access Management (IAM): Manages access to AWS services and resources securely.

  • AWS Key Management Service (KMS): Creates and manages cryptographic keys for encrypting data at rest.

  • Amazon Macie: Discovers, classifies, and protects sensitive data using machine learning and pattern matching.

  • AWS WAF: Protects against common web exploits and provides control over traffic to the application.

Security Pillar

Reliability Pillar

  • Amazon DynamoDB: Provides a NoSQL database for storing and retrieving data with high scalability and availability.

  • AWS Lambda: Ensures fault tolerance by automatically running code in response to events.

  • Amazon S3: Offers durable, secure, and scalable object storage for storing and retrieving data.

  • AWS Step Functions: Coordinates multiple AWS services into serverless workflows, ensuring reliable execution.

  • Amazon SQS: Decouples and scales microservices, distributed systems, and serverless applications with a fully managed message queuing service.

  • AWS Lambda: Allows running code with zero administration, automatically scaling based on demand.

  • Amazon ElastiCache: Provides in-memory caching to improve application performance by reducing the load on databases.

  • Amazon API Gateway: Acts as the entry point for serverless API requests, efficiently managing and processing incoming traffic.

  • AWS Auto Scaling: Automatically adjusts the capacity of resources to maintain steady, predictable performance at the lowest possible cost.

  • Amazon Textract: Extracts text, handwriting, and structured data from scanned documents and images, improving the efficiency of document processing.

  • Amazon Comprehend Medical: Uses natural language processing (NLP) and machine learning to extract relevant medical information from unstructured text, enhancing the accuracy and speed of claims processing.

Performance Efficiency Pillar

Cost Optimization
Pillar

  • AWS Lambda: Enables paying only for compute time consumed, reducing costs compared to provisioning servers.

  • Amazon S3 Intelligent-Tiering: Automatically optimizes storage costs by moving data between access tiers based on usage patterns.

  • AWS Budgets: Sets custom cost and usage budgets, sending alerts when thresholds are exceeded.

  • Amazon CloudWatch: Provides cost and usage metrics, enabling cost allocation and optimization decisions.

  • AWS Trusted Advisor: Offers real-time guidance to help provision resources optimally, improving performance and reducing costs.

  • Smart.Claim.Imaging IQ can analyze user behavior patterns and optimize the system's resource utilization accordingly. By understanding usage patterns, the solution can dynamically scale resources up or down, ensuring that the infrastructure is not over-provisioned and consuming unnecessary energy.

  • Leveraging serverless architecture patterns, such as AWS Lambda and Amazon S3, can significantly reduce the environmental impact of Smart.Claim.Imaging IQ. Serverless computing allows for efficient resource utilization, as the infrastructure scales automatically based on the actual workload, reducing idle resources and energy waste.

  • Smart.Claim.Imaging IQ can implement data archiving and lifecycle management policies to move infrequently accessed data to more energy-efficient storage tiers, such as Amazon S3 Glacier or Amazon S3 Glacier Deep Archive. By storing data in the most appropriate storage class based on access frequency, the solution can reduce the energy consumption associated with data storage.

  • By leveraging AWS's energy-efficient infrastructure, such as the AWS Nitro System and AWS Graviton2 processors, Smart.Claim.Imaging IQ can benefit from improved energy efficiency and reduced carbon emissions.

Sustainability Pillar

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