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Claim Adjudication Analytics: Automated Bill Review

Client

Leading end-to-end payment integrity organization based in Indiana

Business Problem

  • Our client offers Claim Overpayment & Recovery solutions
  • They partners up with their customers to identify, eliminate and recover overpayments

Objective

Automate the adjudication (bill review) process

Abzooba’s Solution:

  • The solution uses natural language processing to understand the context of the item description and classify each item description into a charge type (e.g. laboratory changes, monitoring charges etc.)
  • The classifications and contract guidelines decide the adjudication

Business Benefits:

  • Increased assessment speed by 40%
  • 90% accuracy with minimal supervision
  • Reduces processing costs immensely
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