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Data & Intelligence

How AI Verifies Insurance Eligibility to Benefit Members & Plans

Artificial Intelligence (AI) continues to mature as companies such as IBM, Amazon, and Google race to bring AI into the daily life of consumers. Underlying the technology of AI is natural language processing, which integrates fields as diverse as linguistics, neuroscience, anthropology, computer science, and psychology. As AI begins to permeate healthcare, its vast potential for improving the way healthcare is delivered, reimbursed, and perceived is rapidly evolving. One key use case of AI today is improving the speed at which health plans and providers are able to verify benefits and eligibility.

As health plans evolve their businesses to stay on top of a rapidly evolving technology landscape, they are presented with many opportunities to improve revenue and profits, while also improving provider and member perception. A seamless and intuitive self-service option that allows for easy insurance verification between providers, members, and health plans reduces call times, improves satisfaction, and increases accuracy and efficiency in in claims processing.

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The current challenges for health plans in regards to benefit verification begins with miskeyed or mismatched patient information, resulting in unsuccessful IDs of patients. This leads to operational inefficiencies between providers and health plans, as well as members who have to wait longer for verification. AI, using advanced natural language processing algorithms, can guide providers, members, and health plans to complete their desired tasks without having to physically type anything in. Less time spent keying patient information in will result in reduced claim denials and reduced verification time. For those providers that call health plans for verification, the result is reduced call times and the ability to free up health plan call center staff for more complex inquiries.

Health plans, providers, and consumers continue to look for ways to receive and deliver quality healthcare at an efficient cost. As tech companies continue to change how healthcare is delivered, health plans have an opportunity to take a step ahead by using AI to delight members and providers by improving the ease and time required to determine insurance eligibility.

What are you doing to delight members and providers?

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Sonia Goraya

Sonia Goraya is a senior business consultant within Perficient's national healthcare practice. She has experience in public health, digital marketing, analytics, and operations. Sonia is passionate about transforming the way businesses value the investment between technology and healthcare while improving health outcomes for patients of all economic backgrounds.

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