top of page

HiPaaS

Get Started
with HiPaaS
Claims AI Models

HiPaaS offers various AI models for payers and providers

​

Edival.png

Claims AI Models for Payers

Claims AI Models
for Providers

ClaimsAI for Payers

  • Integrate historical data with advanced AI algorithms

  • Detect and prevent fraud accurately

  • Analyze patterns and anomalies

  • Identify and mitigate fraudulent activities early

  • Safeguard organization and maintain claims processing integrity

Advanced AI for Fraud Detection

  • Automatically reconcile 837, 835, ERA, treasury records, lockbox transactions, and self-pay files

  • Compare 837 claims and ERA side by side for accuracy and consistency

  • Upload self-pay payment files and lockbox files easily

  • Automate the payment posting process for enhanced efficiency and accuracy

Claims & Payment Auto Comparison

​

  • Implement Robotic Process Automation (RPA) for claims entry

  • Automate work queues based on utilization

  • Handle payment processing efficiently

  • Fix repeating data errors and reduce manual intervention

  • Ensure prompt provider payments, improving cash flow and satisfaction

Payment Process Automation

​

  • Use historical data to create analytics of prior authorization

  • Connect providers and procedure codes to approval/rejection rates

  • Suggest approval or rejection of new prior auth requests based on learning patterns on historical data

Prior Authorization
Auto-Approval Suggestions

​

  • Manage claims seamlessly from submission to resolution

  • Automate coding and the submission process

  • Maximize revenue through streamlined claim handling

  • Ensure submission correctness and compliance

  • Expedite resolutions, benefiting both providers and members

  Complete Claims Lifecycle from
Submission to Resolution

​

  • Utilize AI to predict denials, revenue, and accounts receivable (A/R)

  • Manage denials effectively with Generative AI

  • Improve revenue cycle efficiency

  • Streamline patient self-pay collection

Predict Future Patterns
& Reduce Denials

ClaimsAI for Providers

AI Automated Medical Coding

  • Save time and reduce manual errors with AI-powered medical coding

  • Automatically correct, validate, and suggest code improvements

  • Implement complex coding rules and automated data corrections

  • Minimize rejections and denials

  • Boost coding productivity significantly

Real-time Information including Prior Authorization Handling

  • Apply complex rules and validations for claim submission readiness

  • Fix data issues beforehand

  • Monitor claims status and payments in real-time

  • Manage prior authorizations efficiently

  • Submit supporting documentation and attachments seamlessly

Predict Future Patterns
& Optimize Revenue

  • Utilize AI to predict denials, revenue, and accounts receivable (A/R)

  • Manage denials effectively with Generative AI

  • Enable quick resubmission of denied claims

  • Use historical denial patterns to correct common errors in claim submission

Generative AI for Denial Management

  • Interpret reason codes and denial codes using Generative AI

  • Offer resolution options based on a comprehensive knowledge base

  • Provide configurable automation for repetitive denials

  • Integrate on-demand eligibility and prior authorization checks

  • Enhance denial management and operational efficiency

  Complete Claims Lifecycle from Submission to Resolution

  • Manage claims seamlessly from submission to resolution

  • Automate coding and the submission process

  • Maximize revenue through streamlined claim handling

  • Ensure submission correctness and compliance

  • Expedite resolutions, benefiting both providers and members

Integrated with EHR Systems

  • HiPaaS Payment Posting App available on Connection Hub

  • Seamlessly integrate with EHR workflows

  • Post reconciled payments directly back to EHR systems

  • Compatible with several leading EHR systems

  • Ensure efficient and accurate payment reconciliation

Demos

Case Studies