Saving Millions in Healthcare Claims Processing Costs with AI Workflows

Imagine having such a fast-growing small or medium business (SMB) that your team can’t scale as fast as it brings on new clients. While many might view this as a challenge, one Amazon Web Services customer, MDaudit, saw it as an opportunity to integrate artificial intelligence (AI) into its auditing workflow to improve operations. They help more than 65,000 US healthcare providers and 2,200 facilities strengthen their billing and compliance operations.

Migrating to an AI-powered system would come with a handful of advantages. Not only would it reduce the number of hours required to deliver top-quality service at an affordable price, but it would also help MDaudit reduce its reliance on legacy IT and streamline its operations.

However, MDaudit faced a few unique challenges. For one, healthcare providers receive a huge volume of external audit requests, with essentially zero margin for error. And although medical records are being digitized at an accelerating pace, there are still plenty of tasks that are largely handled on paper. Solving these issues would require sophisticated AI tools.

Smartscan.ai – Trusted AI, verified by humans

At the heart of the matter was a process known as an Additional Documentation Request, which often happens when a health plan decides it needs more information to determine the validity of a medical claim. Healthcare providers receive an average of 2,000 letters per quarter. These requests come in as unstructured PDF documents, from which MDaudit’s software extract data before it could even begin to handle the request. With MDaudit’s Smartscan.ai solution, its customers can scan more letters with less staff and submit evidence to insurance companies to get paid faster.

AWS object storage helps make this possible. Each customer uploads their documents through a unique web portal, which triggers an Optical Character Recognition program to scan the file and convert images of text to machine-readable information. After that, an algorithm identifies a predetermined dataset from each document, including fields such as name, date of birth, and date of service. If you have technical experience, you can read the more in-depth story here.

What happens next is key: MDaudit’s software then compares the formatting of both the character recognition and the algorithm against past examples stored in an AWS database. If those come up with differences, the process runs again with a wider scope and sends the results back to a human to review. Only then, once a real-live person has given the OK, does the document get stored for later government audits.

MDaudit has been able to fully extract 90 percent of the letters successfully in approximately 40 seconds and 10 percent of the letters partially (with more training planned in the future). This has saved an MDAudit customer an average of 15-20 mins per letter, resulting in fewer processing costs and providing a seamless experience. The overall benefit being more productivity and quicker revenue recognition, all enabled by AWS AI-driven technology.

A cost-effective story for customers

Following the huge upheavals wrought by the pandemic, companies in health-related fields operate on slim margins. Whereas once they might have been able to afford to process each and every government audit request by hand, that is no longer feasible given today’s economic realities.

MDaudit was founded with these realities in mind, to help healthcare providers minimize their billing risk and maximize their revenue. Providers can organize and maintain their internal or external audit information efficiently so that when audits do happen, they can operate in a cost-effective fashion. Now, with this new AI-powered workflow, MDaudit saves its clients millions of USD in processing costs—not to mention ensure accuracy and provide customers with a seamless experience.

Extending your runway

The benefits don’t end there. For MDaudit, automation means the company can handle a greater volume of customer requests, giving it a huge amount of new room to grow. “Our innovation strategy involves working with our ecosystem partners, and AWS has been a great strategic partner in our mission to transform healthcare,” said Nisheet Goenka, MDaudit’s vice president of engineering.

That’s huge for a small business, which by necessity is always trying to do more with less. “Our experience working side-by-side with AWS and our extended account team saved us four months of dedicated engineering time,” Goenka said. The solution they came up with together “provides us with meaningful data to support our healthcare customers.”

Next steps­­

Could your SMB benefit from the growing portfolio of AWS AI tools? We offer solutions to solve challenges in customer engagement, fraud detection, process automation, and deriving business insights. If you’re still early in your AI journey, learn more about the value of digitizing your business on AWS Smart Business.