Tericsoft

Accelerating Pre-Authorisation Using AI

Overview: We partnered with our client to revolutionise the complex and cumbersome insurance pre-authorisation processes, a significant challenge for healthcare facilities, insurance providers, and patients.With over a decade of industry expertise, our client identified the need to address manual work, delays, and errors through AI LLM technology. Together, we aimed to streamline the entire pre-authorisation workflow, digitising processes and building an intelligent AI automation platform. We worked on: Product Development: The manual pre-authorisation process was digitized to reduce decision turnaround times and human errors. With Intuitive web interfaces and robust backend microservices technology, the platform was developed with capabilities for ease of use and transparency for all the stakeholders. The system was designed to be scalable to handle growing volumes of patient data seamlessly. End-to-end workflows were optimised to accelerate processing speeds and decision-making. AI Integration: AI LLM was integrated throughout the platform to enable process automation and enhance accuracy. This integration speeds up the processing of information and validates it against guidelines, resulting in lower claim denial rates and improved accuracy enabled by AI. Digital Documentation: The manual-driven pre-authorisation process was digitized by extracting data from E-fax forms through OCR. This eliminated the administrative workload previously required for manual data entry. Overall Impact Created: Enabled the client to expand their customer base by providing faster and more efficient pre authorisation services.Reduced human errors in pre-authorizations through Al-enabled automation, improving information quality for payors.