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Smart.Claim IQ

Smart.Claim IQ is a managed service designed for health insurance plans to efficiently capture, classify, extract, and enrich data from paper-based claims submitted by providers and member plans for reimbursement. By leveraging Amazon's Intelligent Document Processing (IDP) and serverless technologies, Smart.Claim IQ streamlines the claims processing workflow, ensuring accuracy, security, and compliance with the AWS Well-Architected Framework.

Go-to-Solution

Smart.Claim IQ is a game-changer for health insurance plans struggling with the complexity and inefficiency of processing paper-based claims. Our managed service leverages Amazon's cutting-edge IDP and serverless technologies to accurately capture, classify, extract, and enrich data from claims, while ensuring the highest standards of security and compliance. With Smart.Claim IQ, health plans can streamline their claims processing workflow, reduce operational costs, and improve member satisfaction. Our service is designed to seamlessly integrate with existing systems and scale effortlessly to meet the growing demands of the healthcare industry.

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Blue Materials

What we offer ?

Claim IQ is a managed service that captures, classifies, extracts, and enriches data from paper-based claims.

For Who ?

The service is designed for health insurance plans and providers who need to process claims efficiently and accurately.

Smart.Claim IQ utilizes Amazon's IDP and serverless technologies to streamline the claims processing workflow, ensuring security and compliance with the AWS Well-Architected Framework.

How do we Leverage AWS ?

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Financial Benefits

  • Reduced operational costs: By streamlining the claims processing workflow and reducing manual intervention, Smart.Claim IQ helps health plans significantly reduce their operational expenses associated with claims processing.

  • Improved financial accuracy: Smart.Claim IQ's high accuracy in data capture, classification, and extraction reduces the risk of financial errors, such as overpayments or underpayments, helping health plans maintain financial integrity.

  • Lower labor costs: The automation of manual tasks and the reduction of errors minimizes the need for additional staff to handle claims processing, leading to lower labor costs for health plans.

  • Improved fraud detection: Smart.Claim IQ's advanced data analytics capabilities can help identify potential fraudulent claims, reducing financial losses due to fraud and abuse.

  • Increased profitability: By reducing operational costs, improving financial accuracy, and enabling faster reimbursements, Smart.Claim IQ contributes to the overall profitability of health plans.

Operational Benefits

  • Increased efficiency: Smart.Claim IQ automates the claims processing workflow, reducing manual intervention and errors, resulting in improved operational efficiency.

  • Improved accuracy: Amazon's IDP technology ensures high accuracy in data capture, classification, and extraction, minimizing the need for manual corrections and rework.

  • Faster processing times: The service enables quicker processing of claims, leading to shorter turnaround times and faster resolution of claims.

  • Enhanced compliance: The service helps health plans maintain compliance with industry regulations and standards, such as HIPAA, by enforcing secure data handling practices and audit trails.

  • Increased productivity: By automating repetitive and manual tasks, Smart.Claim IQ enables claims processing teams to be more productive and handle a higher volume of claims without additional resources.

Benefits of the Cloud Adoption Framework

Smart.Claim IQ, powered by AWS, revolutionizes claims processing for health plans, delivering unparalleled efficiency, accuracy, and cost savings. By seamlessly integrating with the AWS Cloud Adoption Framework, Smart.Claim IQ aligns with business objectives, enhances employee experiences, strengthens compliance, and optimizes operations. This innovative solution leverages advanced technologies to automate manual tasks, reduce errors, and improve processing times, enabling health plans to deliver faster, more accurate services to members and providers.

Business Perspective

  • Alignment with business objectives: Smart.Claim IQ helps health plans achieve their business objectives by optimizing claims processing operations, reducing costs, and improving member and provider satisfaction.

  • Improved competitiveness: By adopting an efficient and accurate claims processing solution, health plans can differentiate themselves in the market and gain a competitive advantage.

  • Increased agility: The service enables health plans to quickly adapt to changing business needs and regulatory requirements, thanks to the flexibility and scalability of the AWS cloud.

  • Better decision-making: Smart.Claim IQ provides valuable insights into claims processing performance, enabling health plans to make data-driven decisions and identify areas for improvement.

People Perspective

  • Enhanced employee experience: By automating manual and repetitive tasks, Smart.Claim IQ improves the work experience of claims processing staff, allowing them to focus on more meaningful and value-added activities.

  • Skill development: The adoption of Smart.Claim IQ encourages employees to develop new skills related to cloud technologies, data analytics, and process optimization, fostering a culture of continuous learning and improvement.

  • Improved collaboration: The service promotes collaboration between different teams, such as claims processing, IT, and finance, by providing a common platform and data repository for claims processing activities.

Governance Perspective

  • Strengthened compliance: Smart.Claim IQ helps health plans maintain compliance with industry regulations and standards, such as HIPAA, by enforcing secure data handling practices and providing audit trails.

  • Improved risk management: The service reduces the risk of errors, fraud, and financial losses by automating claims processing tasks and implementing advanced data analytics capabilities.

  • Better policy enforcement: Smart.Claim IQ enables health plans to enforce their claims processing policies and procedures consistently across the organization, ensuring standardization and adherence to best practices.

Platform Perspective

  • Seamless integration: Smart.Claim IQ leverages Amazon's IDP and serverless technologies, enabling seamless integration with existing systems and workflows, minimizing disruption to current processes.

  • Scalability and flexibility: The service allows health plans to easily scale their claims processing capabilities up or down based on demand, without the need for manual infrastructure management, providing flexibility to accommodate growth and change.

  • Improved performance: By leveraging the power of AWS cloud technologies, Smart.Claim IQ delivers high-performance claims processing capabilities, ensuring fast and reliable processing of large volumes of claims.

Security Perspective

  • Enhanced data security: Smart.Claim IQ prioritizes data security by implementing best practices and controls, such as encryption, access management, and network security, to protect sensitive healthcare information.

  • Compliance with security standards: The service helps health plans maintain compliance with security standards, such as HIPAA and SOC, by leveraging the security features and certifications of the AWS cloud platform.

  • Improved incident response: Smart.Claim IQ's integration with AWS security services, such as Amazon GuardDuty and AWS Security Hub, enables quick detection and response to security incidents, minimizing the impact of potential breaches.

Operation Perspective

  • Streamlined operations: Smart.Claim IQ streamlines claims processing operations by automating manual tasks, reducing errors, and improving processing times, leading to increased operational efficiency.
    Improved service delivery: The service enables health plans to deliver faster and more accurate claims processing services to members and providers, improving overall service quality and satisfaction.

  • Better resource utilization: By automating claims processing tasks, Smart.Claim IQ allows health plans to optimize their resource utilization, freeing up staff to focus on higher-value activities and improving overall productivity.

  • Continuous improvement: The service provides health plans with valuable insights into claims processing performance, enabling continuous monitoring, optimization, and improvement of operations.

Leveraging AWS Well-Architected Framework

By leveraging these AWS products and aligning them with the five pillars of the AWS Well-Architected Framework, Smart.Claim IQ can deliver a robust, secure, and cost-effective serverless architecture for claims processing that meets the unique needs of health plans.

Core AWS products essential for Smart.Claim IQ to comply with the AWS Well-Architected Framework using a serverless architecture are:

  • Amazon Textract for efficient extraction of text, handwriting, and data from scanned claim documents.

  •  AWS Lambda for scalable and efficient execution of claims processing logic in a serverless compute environment.

  • Amazon S3 for highly durable and available storage of scanned claim documents, with integration to Amazon S3 Glacier for long-term archival and cost optimization.

  • Amazon DynamoDB for storing extracted and processed claim data in a serverless NoSQL database with high scalability and availability.

  • Amazon Comprehend Medical for identifying and extracting relevant medical information from unstructured text, improving the accuracy and completeness of claims data.

The Core

Operational Excellence Pillar

  • AWS CloudFormation: This service enables the automated deployment and management of the serverless infrastructure, ensuring consistent and reproducible environments.

  • AWS Step Functions: Used to define and orchestrate the serverless workflow for processing claims, allowing for efficient coordination of multiple AWS services.

  • Amazon CloudWatch: Provides monitoring and logging capabilities to track the performance and health of the serverless claims processing system, enabling proactive issue resolution and optimization.

  • AWS Identity and Access Management (IAM): Manages access permissions for the serverless components, ensuring that only authorized users and services can access sensitive claims data.

  • AWS Key Management Service (KMS): Enables encryption of sensitive data at rest and in transit, providing an additional layer of security for protected health information (PHI).

  • Amazon Cognito: Implements user authentication and authorization for the claims processing API, ensuring secure access to the system.

  • AWS Secrets Manager: Securely stores and manages sensitive configuration values, such as database credentials, ensuring they are protected and easily rotatable.

Security Pillar

Reliability Pillar

  • Amazon S3: Provides highly durable and available storage for scanned claim documents, ensuring data is protected against loss and accessible when needed.

  • Amazon S3 Glacier: Archives older claim documents for long-term storage and compliance, while optimizing costs for infrequently accessed data.

  • Amazon DynamoDB: Stores the extracted and processed claim data in a serverless NoSQL database, providing high scalability and availability for real-time claims processing.

  • AWS Lambda: Processes claims data reliably and scales automatically based on demand, ensuring the system can handle varying workloads without manual intervention.

  • Amazon Textract: Extracts text, handwriting, and data from scanned claim documents efficiently, enabling accurate data capture and reducing manual processing times.

  • Amazon Comprehend Medical: Identifies and extracts relevant medical information from unstructured text, such as medical codes and diagnoses, improving the accuracy and completeness of claims data.

  • AWS Lambda: Executes the claims processing logic in a scalable and efficient serverless compute environment, ensuring optimal performance and resource utilization.

  • Amazon API Gateway: Creates and manages the API endpoints for the claims processing system, providing a secure and efficient interface for integrating with other systems.

  • Amazon S3 Transfer Acceleration: Accelerates the upload of scanned claim documents to Amazon S3, reducing latency and improving the overall performance of the claims processing workflow.

Performance Efficiency Pillar

Cost Optimization
Pillar

  • AWS Lambda: Allows health plans to pay only for the compute time consumed during claims processing, avoiding the need for idle resources and reducing overall compute costs.

  • Amazon S3 Intelligent-Tiering: Optimizes storage costs by automatically moving claim documents between access tiers based on usage patterns, ensuring the most cost-effective storage option is used.

  • Amazon DynamoDB On-Demand: Enables health plans to pay only for the read and write requests made to the claims database, eliminating the need for upfront capacity planning and reducing costs during periods of low usage.

  • AWS Cost Explorer: Provides visibility into the costs associated with the serverless claims processing system, enabling health plans to monitor and analyze spending patterns and identify opportunities for optimization.

  • AWS Budgets: Allows health plans to set custom budgets and receive alerts when costs exceed predefined thresholds, helping to avoid unexpected spikes in spending and maintain cost control.

  • AWS Lambda: By using serverless compute, Smart.Claim IQ can reduce energy consumption and carbon footprint compared to traditional server-based architectures, as it only consumes resources when processing claims.

  • Amazon S3 Glacier: Archiving older claim documents in Glacier reduces the environmental impact of long-term storage by using low-power storage technologies and minimizing data center space requirements.

  • AWS Auto Scaling: Automatically adjusts the number of processing instances based on demand, ensuring that resources are not over-provisioned, thus reducing energy waste.

  • AWS Graviton2 Processors: Choosing Graviton2-powered instances for compute-intensive workloads can significantly reduce energy consumption and improve the overall sustainability of the claims processing system.

  • AWS Region Selection: By deploying Smart.Claim IQ in AWS Regions that have a higher mix of renewable energy sources, health plans can reduce the carbon footprint associated with their claims processing operations.

Sustainability Pillar

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