There isn’t a health insurance company out there that doesn’t advertise in some way on oversized billboards with excellent copywriting and appealing photos how satisfied its customers are, how easily it handles all insurance claims and how quickly they are processed. In order to not only attract customers but also retain them, improving the customer experience is one of the most important issues for health insurance companies to focus on. Interactions between health insurers and customers must be satisfactory, regardless of the channel, while at the same time, in the background, health insurers are trying to further reduce their costs. This requires a smart approach to free health insurance employees from manual and time-consuming work, which very often involves capturing and reviewing billing documents, among other things, and redeploy them to more valuable work. The intelligent approach is called IDP (Intelligent Document Processing).

Depending on how invoices are received, invoice verification is a costly core business for health insurers

Checking and processing invoice documents are part of the core business of health insurers. The invoices are largely received either directly from the doctor’s office or the hospital or, depending on how they are received, are submitted by the customer himself. Health insurers must check the incoming invoices for various aspects and errors, including, for example:

  • Is the service provider authorized to provide the treatment within the scope of insurance?
  • Is there appropriate coverage for the insured person?
  • Are the tariff items correct and is the treatment tariff correct?
  • Can the treatment be reimbursed?

Claims management is partially automated with numerous verification rules to identify erroneous and abusive billing documents.

Large health insurers have automated around two-thirds of their invoice verification, while smaller health insurers (less than 100,000 invoices per year) have automated only one-fifth – which still means millions of invoices that are not automated

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Good values with potential for improvement

Depending on the size of the health insurer, between just under half and around two-thirds of invoices are received digitally, which also roughly reflects dark processing (fully automated processing and release of invoice documents): According to the study on billing and performance control at health insurers, of just under 110 million invoice documents, around 75 million were processed automatically at health insurers in Switzerland in 2018. Even if this already represents a proud sum and enables premium reductions, millions of invoice documents (and other documents) still remain that have to be entered and processed manually.

Various difficulties with paper invoice documents

In any case, health insurance companies must first digitize paper invoices before they can be processed further. This involves a massive amount of work, and digitization is not always so easy. The greatest difficulties here relate to invoice documents from abroad resulting from emergency treatments. On the one hand, specific service areas with different descriptions make automated verification difficult, but on the other hand, the different forms of invoice documents are also a problem: For a full 80% of health insurers, foreign invoices are not machine-readable, which means that (until now) only manual capture remains for digitization.

IDP combines advanced AI technologies to help capture and process invoice receipts

IDP as a solution to this problem

This is exactly where part of the problem lies buried. As soon as paper documents vary in form, the rapid capture to digitize and process invoice documents is over. Handwritten notes are added to unstructured billing documents, making processing impossible. That’s why it pays for health insurers to take a smarter approach to automation with IDP (Intelligent Document Processing). A combination of several advanced artificial intelligence-based technologies, IDP creates a whole new spectrum of possibilities for automating capture and processing. Using machine learning-based OCR (Optical Character Recognition), not only can unstructured (even handwritten) documents and paper invoice receipts be captured and processed automatically, IDP also helps in the verification of benefit claims. We will go into detail about IDP and its features here.

IDP brings a powerful solution to the specifics of health insurers’ billing records and documents

Thanks to IDP, health insurers can address the peculiarities and irregularities in billing records and documents, which has a positive impact on better billing control, allows for cost reductions in insurance premiums, and ultimately closes the loop on customer satisfaction.