Claims & Payments Auto-Comparison AI Model

Problem Statement:

Reconciling healthcare claims and payments is a complex, time-consuming task that involves manually comparing multiple data sources, such as 837 claims, 835 remittance advice, ERA (Electronic Remittance Advice), treasury records, lockbox transactions, and self-pay files. Manual reconciliation is prone to errors, leading to discrepancies that can disrupt the revenue cycle, delay payments, and increase administrative burdens.

HiPaaS Solution:

The HiPaaS Claims & Payments Auto-Comparison AI model is designed to streamline and automate the reconciliation process. Built on over 1 TB of claims and payments datasets, this advanced AI model offers:

• Automated Reconciliation: Accurately compares 837 claims, ERA, and 835 files side by side, ensuring consistency and accuracy across all records.

• Efficient Payment Posting: Automates the payment posting process, reducing errors and enhancing operational efficiency.

• Seamless Integration: Easily upload self-pay payment files and lockbox transactions for automatic reconciliation, minimizing manual intervention and improving overall workflow efficiency.

Deployment and Implementation: HiPaaS offers flexible deployment options (cloud or on-premise) and an intuitive UI for quick setup, minimizing disruption to existing workflows and rapid time-to-value.

Client-Centric Approach for Customization and Support: HiPaaS emphasizes its commitment to addressing clients' unique needs through custom data solutions and dedicated support.

• Custom Data Solutions: While the AI model supports standard data formats, the HiPaaS team also collaborates closely with clients to develop tailored solutions that accommodate their specific data formats and compliance requirements such as HiPAA.

• Dedicated Support: HiPaaS provides ongoing support including assistance with implementation, configuration, training, troubleshooting, and continuous improvement initiatives.

This client-centric approach ensures that the HiPaaS solution is not just a one-size-fits-all product, but a flexible and adaptable tool that evolves with the unique needs of each healthcare organization.