CERIS Announces Innovations in Artificial Intelligence and Machine Learning That Improve Payment Integrity
2023年11月14日 - 9:18PM
Advancements in artificial intelligence (AI) and machine learning
(ML) are significantly improving results and efficiencies for
payment integrity in medical claims, according to CERIS, a CorVel
company.
“CERIS leads the industry in leveraging AI and ML to automate
tasks for greater efficiency and accuracy, to find patterns that
may indicate fraud or systemic errors, to interpret medical
language, and to summarize large amounts of information into
actionable data,” said Steve Sutherland, Senior Vice President of
Information Systems for CERIS, a Fort Worth-based company that has
pioneered the use of this technology for payment integrity.
Sutherland notes, “Now, generative AI and machine learning are
taking productivity and savings even further. For example, by
efficiently using machine learning, we can more effectively
identify claim combinations with high probability of upcoding,
flagging them for review by the claim professionals. We can
summarize medical documents, extract keywords, answer specific
questions, and bring often overlooked items to the reviewer's
attention. As a result, payers can more efficiently pay medical
bills that are accurate and appropriate for the claim.”
Already, optical character recognition (OCR) and document
extraction have increased throughput significantly. Additional
benefits to CERIS clients include improved accuracy, faster
turnaround time, and increased savings ratios.
Incorporating this technology also allows review teams to spend
less time on tedious manual analysis so that they can focus on
higher-value, more enriching work that better serves client needs.
By making their work more rewarding and meaningful, valuable
employees have higher job satisfaction and are more engaged,
improving employee retention. CERIS’ leadership in technology
elevates the efforts of professional staff and improves the
outcomes delivered to clients.
Speed and precision are essential for maintaining payment
integrity in healthcare, where payers have a responsibility to
promptly and accurately reimburse providers, thus avoiding
time-consuming efforts to recover erroneous payments. Prepayment
review is becoming the norm – making it even more important to
determine if a bill is accurate in a timely manner. Utilizing these
new technologies improves the process and the experience of payers
and providers.
About CERIS
CERIS, a leader in both prospective and retrospective claims
review and repricing, combines clinical expertise and cost
containment solutions to ensure the accuracy and transparency in
healthcare payments. Accuracy and validation services include
itemization review, DRG validation, facility repricing, contract
and policy applications, review of implants and devices, and
primary payer cost avoidance. Its universal chargemaster contains
billions of charge items from more than 97% of the nation’s
hospitals, helping to ensure the accuracy and objectivity of each
claim review.
Contact: Melissa StoranPhone:
949-851-1473www.corvel.com
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