Health insurance claims automation prioritizes people first

In our previous blog, we examined the complexities of healthcare insurance claims processing that have real consequences for patient care— delayed treatments, financial hardships, and eroded trust in the healthcare system. We explored how generative AI improves patient outcomes through claims automation, ultimately ensuring that patients receive the timely, affordable care they need.

Now, we take a deeper dive into Neudesic’s Document Intelligence Platform—an AI-powered solution designed for claims automation that keeps patients and providers at the heart of the transformation. While automation often focuses on cost reduction, our focus here is on the human impact: improving experiences, reducing administrative burdens, and ensuring faster reimbursements for all stakeholders involved.

7 steps to successful claims automation

The journey of a health insurance claim is complex, involving multiple steps from initial intake to adjudication, stressing the importance of claims automation. Neudesic’s Document Intelligence Platform optimizes each stage of claims processing using AI-driven modules that reduce errors, speed up processing, and improve accuracy. By minimizing manual intervention, payers can significantly decrease processing time, reduce administrative bottlenecks that often delay care, and provide faster reimbursements for patients.

There are 7 steps to successful claims automation to foster better health outcomes across the board.

1. Pre-processing

The first step in automating claims processing is pre-processing, where the platform ingests and prepares incoming documents for classification and extraction. By ensuring all documents are in a machine-readable format, this step minimizes errors and sets the foundation for accurate data extraction. As a result, pre-processing reduces data inconsistencies early in the process, preventing downstream errors and rework.

2. Document type classification

Using AI-powered classification, the various claim forms are identified and routed to the appropriate workflows, ensuring that each claim is processed according to its specific requirements. This step enhances efficiency by directing claims to the right processing stream without manual sorting, reducing processing delays and human error.

3. Benefit type classification

Once classified, the claims undergo benefit type classification, where the platform determines the relevant coverage category—medical, dental, vision, or another benefit type. By directing each claim to the appropriate processing workflow, this step ensures accurate application of benefit-specific rules and calculations. Consequently, this reduces claim misrouting, improving the accuracy of benefit application and ensuring faster approvals.

4. Extraction

The fourth step is extraction, where the platform leverages AI-driven techniques to capture critical claim details such as member information, procedure codes, and billed amounts. Whether dealing with structured forms, unstructured documents, or complex medical charts, the platform dynamically extracts relevant data. This ensures high accuracy even when working with varied document layouts.

5. Business rules application

The system standardizes provider and member data, aligns procedure codes, and segments multi-transaction claims. By enforcing consistency across different claim components, this step ensures that the extracted information is ready for validation and adjudication. It also ensures uniformity across claims, improving data integrity and reducing claim disputes.

6. Validation

Validation is a crucial step to maintain accuracy and compliance. The platform performs thorough checks to ensure completeness, logical consistency, and alignment with reference data. By automating these validation checks, payers can experience reduced claim denials due to missing or incorrect information, ensuring that only clean, accurate claims move forward in the process.

7. Adjudication

In this step, claims are either approved for Straight-Through Processing (STP) or flagged for manual review if exceptions arise. STP enables faster reimbursements by allowing fully validated claims to move directly to payment processing without manual intervention. For more complex cases, flagged claims are directed to human adjudicators for further assessment. This significantly accelerates payment cycles, ensuring that patients and providers receive timely reimbursements.