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Smart.Claim.Rx IQ

Smart.Claim.Rx IQ is a managed service designed to revolutionize the way health insurance companies process paper-based prescription drug claims submitted by pharmacies. By leveraging Amazon Intelligent Document Processing (IDP) and other serverless AWS products, Smart.Claim.Rx IQ streamlines the capture, classification, extraction, enrichment, review, and validation of claim data. This service enables insurance companies to automate manual processes, improve accuracy, reduce costs, and enhance the overall efficiency of their claim processing workflows.

Go-to-Solution

Smart.Claim.Rx IQ is a game-changing managed service that revolutionizes the way health insurance companies process paper-based prescription drug claims.  With Smart.Claim.Rx IQ, insurance companies can focus on delivering exceptional customer experiences and driving business growth in the competitive healthcare industry.

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What we offer ?

Smart.Claim.Rx IQ is a managed service that automates the processing of paper-based prescription drug claims submitted by pharmacies to health insurance companies.

For Who ?

The service is designed for health insurance companies looking to streamline their claim processing workflows and improve efficiency.

Smart.Claim.Rx IQ utilizes Amazon IDP and AWS's serverless products to capture, classify, extract, enrich, review, and validate claim data, automating manual processes and reducing errors.

How do we Leverage AWS ?

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Financial Benefits

  • Reduced operational costs associated with manual claim processing

  • Optimized resource allocation, freeing up staff for higher-value tasks

  • Potential for increased revenue through improved claim processing efficiency

  • Lower infrastructure costs due to the use of serverless architecture

  • Cost savings from reduced errors and faster claim settlements

Operational Benefits

  • Automated claim processing, reducing manual efforts

  • Increased accuracy and reduced errors in data extraction and validation

  • Faster claim processing times, leading to improved customer satisfaction

  • Scalable and flexible architecture to handle varying claim volumes
    Enhanced compliance with regulatory requirements and data security standards

Benefits of the Cloud Adoption Framework

By integrating Smart.Claim.Rx IQ with the AWS Cloud Adoption Framework, insurance companies can realize significant benefits across multiple perspectives. From business agility and customer experience to employee empowerment, regulatory compliance, scalability, security, and operational efficiency, Smart.Claim.Rx IQ enables insurance companies to transform their claim processing operations and thrive in the digital age. 

Business Perspective

  • Digital Transformation: Smart.Claim.Rx IQ enables the digital transformation of claim processing workflows, allowing insurance companies to modernize their operations and stay competitive in the evolving healthcare industry.

  • Improved Customer Experience: By automating claim processing and reducing processing times, Smart.Claim.Rx IQ helps insurance companies deliver faster and more accurate claim settlements, leading to improved customer satisfaction and loyalty.

  • Enhanced Competitiveness: Adopting Smart.Claim.Rx IQ positions insurance companies as technology leaders in the industry, enhancing their competitive advantage and ability to attract and retain customers.

  • Business Agility: The scalable and flexible architecture of Smart.Claim.Rx IQ allows insurance companies to quickly adapt to changing business needs, support growth, and handle varying claim volumes efficiently.

People Perspective

  • Employee Empowerment: Smart.Claim.Rx IQ empowers employees by automating manual and repetitive tasks associated with claim processing, allowing them to focus on higher-value activities such as customer service, analysis, and decision-making.

  • Improved Employee Satisfaction: By reducing the burden of manual claim processing, Smart.Claim.Rx IQ contributes to improved employee satisfaction and engagement, as staff can dedicate their time to more meaningful and rewarding work.

  • Skills Development: Adopting Smart.Claim.Rx IQ provides opportunities for employees to upskill and reskill in areas such as automation, artificial intelligence, and cloud technologies, fostering a culture of continuous learning and growth.

Governance Perspective

  • Regulatory Compliance: Smart.Claim.Rx IQ helps insurance companies ensure compliance with healthcare regulations and data privacy standards, such as HIPAA, by implementing secure data handling practices and access controls.

  • Audit and Transparency: The service provides audit trails and transparency in claim processing workflows, enabling insurance companies to demonstrate compliance, track processing activities, and maintain accountability.

  • Data Governance: Smart.Claim.Rx IQ supports data governance best practices, including data security, privacy, and integrity, ensuring that sensitive claim data is handled appropriately throughout the processing lifecycle.

Platform Perspective

  • Scalability and Flexibility: By leveraging AWS's serverless architecture, Smart.Claim.Rx IQ offers scalability and flexibility, allowing insurance companies to handle varying claim volumes and adapt to changing business needs without the need for manual infrastructure management.

  • Intelligent Document Processing: Smart.Claim.Rx IQ utilizes Amazon IDP to provide intelligent document processing capabilities, enabling accurate and efficient extraction of relevant data from paper-based claims.

  • Seamless Integration: The service integrates seamlessly with existing systems and workflows, allowing insurance companies to adopt Smart.Claim.Rx IQ without significant disruption to their current operations.

  • Rapid Deployment and Iteration: AWS's cloud platform enables rapid deployment of Smart.Claim.Rx IQ and supports iterative improvements, allowing insurance companies to quickly realize the benefits of the service and continuously optimize their claim processing workflows.

Security Perspective

  • Robust Security Measures: Smart.Claim.Rx IQ implements robust security measures to protect sensitive claim data, leveraging AWS's security best practices and compliance certifications.

  • Data Encryption: The service ensures data encryption at rest and in transit, safeguarding claim information from unauthorized access or breaches.

  • Access Control and Authentication: Smart.Claim.Rx IQ provides granular access controls and authentication mechanisms, ensuring that only authorized users can access and process claim data.

  • Network Security: By leveraging Amazon VPC, Smart.Claim.Rx IQ ensures network isolation and security, protecting claim data from external threats and unauthorized access.

Operation Perspective

  • Workflow Automation: Smart.Claim.Rx IQ automates claim processing workflows, reducing manual interventions and streamlining operations, leading to increased efficiency and productivity.

  • Proactive Monitoring: The service enables proactive monitoring and alerting for system health and performance, allowing insurance companies to identify and address any issues promptly.

  • Continuous Improvement: Smart.Claim.Rx IQ supports continuous improvement and optimization of claim processing operations, leveraging data insights and feedback to refine workflows and enhance overall performance

Leveraging AWS Well-Architected Framework

By aligning with the Well-Architected Framework and utilizing these AWS products, Smart.Claim.Rx IQ can deliver a highly optimized and resilient claim processing solution that meets the needs of insurance companies while minimizing operational complexity and costs.

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.Rx 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.Rx 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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