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Young Scientist
Performance Lighting

Smart.Claim.Labs IQ

Smart.Claim.Labs IQ is a comprehensive managed service designed to streamline and automate the processing of claims submitted by clinical laboratories to health insurance companies. By leveraging advanced technologies like Amazon Intelligent Document Processing (IDP) and serverless AWS products, Smart.Claim.Labs IQ captures, classifies, extracts, enriches, reviews and validates data from paper-based lab claims. This enables faster, more accurate claims adjudication while reducing administrative costs and ensuring compliance.

Go-to-Solution

Smart.Claim.Labs IQ is the future of lab claims processing for health insurance companies. Our managed service uses cutting-edge AI to read and validate paper claims, enabling automatic adjudication in full compliance with regulations, at a fraction of the time and cost of manual processing. We help health plans save money, move faster, and focus on strategic priorities.

Laboratory
Performance Lighting

What we offer ?

Smart.Claim Labs IQ is an intelligent document processing service that automates data capture and validation for claims submitted by clinical laboratories. Smart.Labs IQ enables labs to process orders faster and more accurately, improve operational efficiency, and enhance access to care.

For Who ?

Health insurance companies seeking to automate and optimize lab claims adjudication.

Smart.Rx IQ leverages Advanced AI, machine learning, and serverless AWS technologies to capture and interpret lab claim data for automatic processing within a secure, scalable cloud infrastructure.

How do we Leverage AWS ?

Financial Benefits
  • Lower administrative and labor costs for claims processing

  • Reduction in costly errors and rework

  • Avoidance of regulatory penalties through improved compliance

  • Faster payment of valid claims (improving provider relationships)

  • Opportunity to redeploy staff to higher-value activities

  • Ability to cost-effectively scale claims operations

Operational Benefits
  • Automated intake, classification and data extraction of lab claims

  • Faster claims processing cycle times

  • Improved accuracy and reduction in manual errors

  • More efficient allocation of limited administrative staff resources

  • Detailed audit trails for compliance and issue resolution

  • Scalable capacity to handle volume fluctuations

Benefits of the Cloud Adoption Framework

By integrating Smart.Claim.Labs IQ with the AWS Cloud Adoption Framework, health insurers can realize significant benefits across multiple perspectives, from improving business agility and cost savings to enhancing security and compliance posture. This holistic approach ensures that the claims processing solution is aligned with the organization's overall cloud strategy and delivers maximum value.

Business Perspective
  • Agility: Smart.Claim.Labs IQ enables health insurers to quickly adapt to changing market demands and regulatory requirements by providing a flexible and scalable claims processing solution.

  • Cost savings: By automating manual processes and reducing errors, Smart.Claim.Labs IQ helps health plans lower their administrative costs associated with claims adjudication.

  • Faster time-to-market: The managed service allows health insurers to rapidly implement and deploy claims processing capabilities without the need for extensive in-house development.

  • Improved customer satisfaction: Faster and more accurate claims processing enabled by Smart.Claim.Labs IQ leads to better experiences for healthcare providers and members.

People Perspective
  • Focus on high-value tasks: Automating routine claims processing tasks allows employees to concentrate on more strategic and value-added activities, such as analytics, provider relations, and member services.

  • Skill development: As manual workloads are reduced, employees can be retrained and upskilled to work with advanced technologies like AI and machine learning, enhancing their career prospects.

  • Improved job satisfaction: Eliminating tedious and repetitive tasks can boost employee morale and job satisfaction, leading to lower turnover and higher productivity.

Governance Perspective
  • Enhanced compliance: Smart.Claim.Labs IQ helps health insurers maintain compliance with industry regulations such as HIPAA by enforcing data privacy and security standards.

  • Audit readiness: The solution maintains detailed audit trails of all claims processing activities, enabling health plans to demonstrate compliance during audits and regulatory reviews.

  • Standardized processes: Integrating Smart.Claim.Labs IQ with the AWS Cloud Adoption Framework ensures that claims processing adheres to industry best practices and standards.

Platform Perspective
  • Scalability: By leveraging AWS's serverless architecture, Smart.Claim.Labs IQ can seamlessly scale up or down based on claims volume, ensuring consistent performance during peak periods.

  • Reliability: AWS's global cloud infrastructure provides high availability and redundancy, minimizing the risk of system downtime or data loss.

  • Interoperability: Smart.Claim.Labs IQ can easily integrate with existing claims management systems and other healthcare IT platforms, enabling seamless data exchange and workflow automation.

Security Perspective
  • Data protection: Smart.Claim.Labs IQ leverages AWS's robust security features, such as encryption, access controls, and network firewalls, to safeguard sensitive claims data.

  • Threat detection: AWS's advanced security services, like Amazon GuardDuty, continuously monitor for potential threats and anomalies, helping health insurers proactively identify and mitigate security risks.

  • Compliance support: AWS provides a range of compliance certifications and attestations, such as HIPAA and SOC, which can help health plans meet their security and privacy obligations.

Operation Perspective
  • Automated monitoring: Integration with AWS CloudWatch enables real-time monitoring and alerting of claims processing metrics, allowing health insurers to proactively identify and resolve issues.

  • Simplified management: AWS's managed services, such as AWS Lambda and Amazon S3, reduce the operational burden of managing underlying infrastructure, freeing up IT resources for higher-value tasks.

  • Continuous improvement: AWS's DevOps tools and practices, like AWS CodePipeline and AWS CodeDeploy, enable frequent updates and enhancements to Smart.Claim.Labs IQ, ensuring the solution remains up-to-date with the latest features and best practices.

Leveraging AWS Well-Architected Framework

By leveraging these AWS products and services across the five pillars of the Well-Architected Framework, Smart.Claim.Labs IQ can build a secure, high-performing, resilient, and efficient serverless architecture. This approach allows the application to scale seamlessly, minimize operational overhead, and optimize costs while ensuring compliance with industry best practices and regulatory requirements.

The core products of the Smart.Claim.Labs IQ solution are carefully selected to align with the AWS Well-Architected Framework and serverless architecture principles.

  • By integrating Amazon Textract and Amazon Comprehend Medical into the relevant pillars of the AWS Well-Architected Framework, Smart.Claim.Labs IQ can build a comprehensive serverless architecture that not only ensures operational excellence, security, reliability, performance efficiency, and cost optimization but also enables intelligent document processing capabilities.

  • Amazon Textract and Amazon Comprehend Medical work together to automate the extraction and interpretation of key information from claims documents, feeding into the serverless processing workflows orchestrated by AWS Step Functions. The extracted data is securely stored in Amazon DynamoDB and can be efficiently retrieved using Amazon ElastiCache for caching.

  • This architecture allows Smart.Claim.Labs IQ to process claims documents at scale, with high accuracy and performance, while maintaining compliance with industry regulations and best practices. The pay-per-use pricing model of the intelligent document processing services helps optimize costs based on actual usage, ensuring cost-effectiveness for health insurers.

The Core

Operational Excellence Pillar

  • AWS CloudFormation: Automate the deployment and management of serverless resources.

  • AWS CloudTrail: Log and monitor API activity for auditing and compliance.

  • Amazon CloudWatch: Monitor and observe the performance of the serverless application.

  • Amazon Textract: Monitor the performance and usage of the OCR and document processing service.

  • Amazon Comprehend Medical: Monitor the performance and usage of the medical NLP service.

  • AWS Identity and Access Management (IAM): Manage user access and permissions to serverless resources, including Amazon Textract and Amazon Comprehend Medical.

  • Amazon Cognito: Implement secure user authentication and authorization for accessing the intelligent document processing capabilities.

  • AWS Key Management Service (KMS): Encrypt and manage sensitive data, including the extracted claims information.

Security Pillar

Reliability Pillar

  • AWS Lambda: Run code without managing servers, automatically scaling based on requests, including the functions for invoking Amazon Textract and Amazon Comprehend Medical.

  • Amazon S3: Store and retrieve claim documents and other static assets, serving as the input source for Amazon Textract.

  • Amazon DynamoDB: Store and retrieve structured claims data extracted by Amazon Textract and analyzed by Amazon Comprehend Medical.

  • AWS Step Functions: Coordinate and orchestrate the serverless components, including the workflows for document processing and medical information extraction.

  • Amazon Textract: Optimize the performance of OCR and document processing by leveraging the service's scalability and parallel processing capabilities.

  • Amazon Comprehend Medical: Optimize the performance of medical information extraction by leveraging the service's pre-trained NLP models and batch processing capabilities.

  • Amazon ElastiCache: Implement in-memory caching for frequently accessed extracted claims data to improve read performance.

  • Amazon CloudFront: Deliver static content and documents with low latency, including the claims documents processed by Amazon Textract.

Performance Efficiency Pillar

Cost Optimization
Pillar

  • AWS Cost Explorer: Analyze and manage AWS costs and usage over time, including the costs associated with Amazon Textract and Amazon Comprehend Medical.

  • AWS Budgets: Set custom cost and usage budgets and receive alerts, taking into account the usage of intelligent document processing services.

  • Amazon S3 Intelligent-Tiering: Optimize storage costs based on usage patterns, automatically moving claims documents between access tiers.

  • Amazon Textract: Optimize costs by using the service's pay-per-page pricing model and leveraging batch processing for high-volume workloads.

  • Amazon Comprehend Medical: Optimize costs by using the service's pay-per-request pricing model and leveraging batch processing for high-volume workloads.

  • AWS Customer Carbon Footprint Tool: Tool for measuring, tracking, and reducing the carbon footprint of AWS usage.

  • AWS Graviton2 Processors: These energy-efficient processors, built on Arm architecture deliver up to 40% better price-performance than comparable x86-based instances, which can lead to reduced energy consumption and carbon footprint.

  • AWS Lambda and Serverless Architecture: By utilizing serverless compute services like AWS Lambda, Smart.Claim.Labs IQ can minimize resource consumption by scaling automatically based on demand.

  • Amazon S3 Lifecycle Policies: By implementing S3 Lifecycle policies, Smart.Claim.Labs IQ can automatically transition older lab order documents to lower-cost storage tiers. This not only optimizes storage costs but also reduces the environmental impact associated with maintaining data on high-performance storage systems.

  • AWS Auto Scaling: By dynamically scaling resources up and down, the solution can minimize energy consumption during periods of low usage, contributing to a more sustainable infrastructure.

  • AWS CloudWatch and AWS Cost Explorer: By regularly analyzing usage patterns and costs, clinical laboratories can identify opportunities to reduce their environmental impact and operating expenses.

Sustainability Pillar

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