Streamlining Healthcare Contracts
Health plans spend $3 billion annually to maintain provider data quality and contracts. Provider contracts today are managed manually, impacting cost and quality of provider data. Lack of quality and rigor in demographic information and pricing configuration results in compliance and administrative risks for health plans. Health plans grapple with provider contract loading complexities due to frequent amendments for new business ventures and unique contracts for each business line and insurance type. These complexities lead to extensive manual work, increasing the risk of errors and slowing down contract processing, which impacts both payments and compliance.
Our Intelligent Provider Contracts solution leverages AI to extract, validate, enhance and load provider demographic and pricing information from contracts, improving provider data accuracy and operations for plans.
The Difference AI Makes
~95%
Reduction in Contract
Loading Time
10%-30%
Reduction in
Claims Interest Payment
3%-5%
Reduction in
Claim Adjustment Rate
70%-90%
Improvement in time
to update Directories
20%-30%
Reduction in
Administrative Costs
Inside Provider Contract Management
Smarter, Faster Provider Contract Processing with AI
Digitize Contracts
Our solution digitizes contracts by ingesting and analyzing data from varied formats and sources, simplifying extraction and reducing complexities related to multiple contract types and formats.
Extract Contract Data
The system adeptly extracts crucial data like demographics, rates, terms, and codes, reducing manual errors and enhancing accuracy in provider information and pricing configuration.
Data Quality Checks
Our solution ensures robust data integrity through customizable, market-specific quality checks, tailored to various source requirements and risk thresholds.
Data Validation
This feature flags discrepancies and validates provider data using a blend of external and internal sources and rules, achieving over 95% accuracy in provider data recommendations.
Load to Source Systems
Our system efficiently loads processed and validated data into source systems in required formats, streamlining updates to contract management, provider data & pricing systems
Take Control Of Your Contracts With AI
Model Tuning
Adaptive Learning
Seamless Integration
Model Tuning
Data-Driven Model Tuning and Rule Updation
Models are developed with client-specific contract data. The learnings and predictions of these models will enhance client’s existing business rules to eliminate human interventions and interpretations in the contract load processes.
Adaptive Learning
Adaptive Learning Solutions for Exponential AI
Our Adaptive Learning Solutions for Exponential AI revolutionize the way organizations approach skill development and knowledge retention. By utilizing advanced AI algorithms, personalized learning paths are created based on individual learner’s strengths, weaknesses, and learning preferences. This results in optimized learning experiences that adapt in real-time to ensure maximum knowledge absorption and retention.
Seamless Integration
Seamless Integration Solutions for Exponential AI
Our Seamless Integration Solutions for Exponential AI streamline the process of integrating AI technologies into existing systems and workflows. We provide robust integration frameworks and APIs that ensure compatibility and smooth data exchange between AI applications and enterprise systems. This seamless integration enhances operational efficiency, data accuracy, and decision-making capabilities.
Prior Authorization
Leverage GenAI and Large Language Models (LLMs) to assess prior authorization requests and direct them to clinical staff for prompt interventions. Generate real-time requests for information to enhance…
Coordination of benefits (COB)
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Claims AI
Improve auto adjudication rates and claims quality with real-time intelligent claim edits. Predict and orchestrate potential claim suspensions to reduce and resolve any manual intervention.
Achieve Accurate, Reliable, And Streamlined
Provider Data Management
Try our solution today