The various APIs help insurance companies in quicker adjudication process, enable pharma companies with their marketing strategy and finance companies to develop new loan solutions

Medical Auto Encoder (MAE)

IHX proprietary algorithm enables extraction of various medical entities from discharge summaries including primary diagnosis, diseases, conditions, procedures (surgical and radiological), medications, and negated conditions, amongst others. The medical entities extracted are also mapped to their corresponding SNOMED and ICD10-CM codes with the intent of accurately and definitively portraying the clinical journey of a patient at the hospital from admission to discharge for medical billing and insurance purposes resulting in

  • Better capture of all procedures resulting in accurate adjudications
  • Reduced queries to hospitals reducing processing time
  • 25 % - 40 % reduction in tabulation and adjudication payroll cost

MAE uses state-of-the-art Natural Language Processing (NLP) / Natural Language Understanding (NLU) technologies along with custom language models specifically built to handle Indian medical terminologies.

Bill Summary Digitization

IHX allows payers to digitize all incoming bills using a multi-class text-based Machine Learning algorithm to classify and map extracted line items with 95%+ extraction accuracy. This product differentiates itself through a novel design based on a first principles approach. It is scalable across 1,000s of hospitals, and has a uniform master column mapping to several desired columns irrespective of the hospital format. The output format is easy to consume for enabling auto application of policy and medical adjudication rules, thereby taking the industry closer to auto-adjudication of insurance claims.
Benefits rendered by the engine include

  • More than 40 % reduction in tabulation and adjudication payroll cost
  • Guided QC framework thereby reducing QC time/effort
  • Highly accurate ML algorithm for mapping and NME classification
  • Improved visibility on cost of claims across providers and procedures
  • Ability to systematically manage and optimize provider network to reduce cost of care

Document Recognition and Indexation

Hospitals and payers transact across different documents which are used in the various phases of claims processing. This IHX engine recognizes and indexes various kinds of documents associated with insurance submission including

  • KYC document recognition
  • Claim Form
  • Declaration Form
  • PAN card
  • Summary Bill
  • Detailed Bill
  • Discharge Summary
  • Lab Reports
  • Radiology Report

Integrated with the Digital claims management platform, this engine proactively alerts users during document uploads on any on missing documents thus reducing round trips related to missing information.

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