Enabling Pre-auth in Less Than 2 Minutes & Final Claims Discharge Under 15 Minutes: ALFRED HEALTH CLAIMS by ARTIVATIC.AI

The ALFRED Health Claims Platform by Artivatic Health leverages advanced AI and ML technologies to streamline the health claims process, ensuring compliance with the IRDAI’s guidelines.

The ALFRED Health Claims Platform by Artivatic Health (Artivatic.ai) is designed to streamline and expedite the health insurance claims process, ensuring compliance with the IRDAI’s stringent guidelines. Here’s a comprehensive look at how ALFRED HEALTH not only meets but exceeds regulatory requirements, delivering a seamless experience for both insurers and policyholders.

ALFRED HEALTH CLAIMS PLATFORM By ARTIVATIC HEALTH

1. Automated Pre-authorization:

• Requirement: Insurers must strive for 100% cashless claim settlement and decide on pre-authorization requests within one hour​​.
• ALFRED Compliance: The platform automates pre-auth checks and eligibility confirmation, ensuring decisions are made in under 2 minutes, significantly faster than the one-hour mandate.

2. Final Authorization for Discharge:

• Requirement: Final authorization for discharge from the hospital must be granted within three hours​​.
• ALFRED Compliance: ALFRED ensures final discharge authorization within 15 minutes, well within the stipulated three hours.

Key Innovative Solution Features

1. Automated Pre-authorization and Discharge

• Pre-authorization: The platform automates pre-authorization checks, delivering decisions in under 2 minutes. This surpasses the IRDAI’s requirement of one-hour decision-making, ensuring a swift start to the claims process.
• Final Discharge Authorization: ALFRED ensures that final discharge authorizations are completed within 15 minutes, significantly faster than the mandated three hours.

2. In-depth Medical Code Verification

ALFRED performs comprehensive checks on medical codes, treatments, surgeries, and diseases to ensure that every claim is accurate and legitimate. This reduces errors and prevents fraudulent claims, aligning with the IRDAI’s focus on fraud prevention.

3. Fraud Intelligence

The platform uses advanced AI to analyze over 1000 data attributes, detecting and preventing fraudulent claims. This proactive approach ensures financial integrity and trust in the claims process.

4. Medical Bills and Documents Digitization

By digitizing medical bills and documents, ALFRED facilitates efficient and accurate claims processing. This digital transformation ensures that all required documents are processed quickly and accurately.

5. Real-time Communication

ALFRED enables real-time communication between healthcare providers and insurers, ensuring that information flows seamlessly and that claims are processed without delays.

6. Automated Validation Checks

The platform conducts automated validation checks against policy documents, pre-existing conditions, historical claims data, and policy benefits and limits. This ensures that all claims are processed in compliance with regulatory standards.

7. Automated Tariff Checks and Pricing Contracts

ALFRED ensures adherence to pricing contracts and accurate tariff checks, preventing overcharging and ensuring correct billing.

8. Hospital and Provider Validation

Comprehensive validation checks on hospitals and healthcare providers ensure that they meet the required quality standards, aligning with the IRDAI’s emphasis on high service standards.

9. Prescription and Medical Bills Analysis

The platform uses AI to analyze prescriptions and medical bills, verifying their accuracy and legitimacy. This ensures that all claims are justified and valid.

Data-driven Insights and Analytics

• ALFRED provides a robust data foundation for generating nudges, insights, alerts, and key performance indicators (KPIs). This includes dashboards, analytics, MIS reports, trends, and more. These tools help insurers continuously improve the claims process and ensure ongoing compliance with IRDAI regulations.

Quick Go-to-live Implementation

• One of the standout benefits of ALFRED is its quick go-to-live capability. The platform can be implemented within 30 days with minimal integration requirements. This rapid deployment ensures that insurers can quickly enhance their claims processing capabilities without extensive delays or resource investments.

How ALFRED HEALTH by Artivatic.ai Helps

• For Insurers: ALFRED improves operational efficiency, reduces turnaround times, and ensures compliance with regulatory standards. Its advanced fraud detection capabilities also protect against financial losses.
• For Policyholders: The platform offers a hassle-free claims experience, with faster pre-authorization and discharge processes. Real-time communication and automated validation checks ensure that claims are processed accurately and promptly.

The ALFRED Health Claims Platform by Artivatic.ai is a game-changer in the health insurance industry. By leveraging advanced AI and ML technologies, it provides a comprehensive solution that meets regulatory requirements, enhances efficiency, and delivers a superior claims processing experience. With its rapid go-to-live capability, ALFRED enables insurers to quickly adapt and improve their services, benefiting both the insurers and the policyholders.

For more detailed information or to see how ALFRED can transform your health claims process, please reach out to us at contact@artivatic.ai

Read more: https://blog.artivatic.ai/p/pre-auth-claims-discharge-15mins-artivatichealth