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Take Hold of Claims Processing

AI-driven Automation to optimize processes for speed and efficency

Overview
In the healthcare industry, Tungsten Automation transforms claims processing by addressing the many challenges including slow processing, coding and content complexity, limited visibility and tracking, and customer dissatisfaction. Manual processes create bottlenecks, prolonging processing times and increasing operation costs by 20-30% for enterprises. Our innovative solutions, powered by advanced technologies such as AI and machine learning, optimize every facet of this critical process. From automating claims intake to intelligent decision-making and fraud detection, our platform accelerates operations while ensuring precision and compliance. Amidst rising patient volumes and stringent regulations, healthcare providers face mounting pressure to handle claims efficiently. Tungsten Automation equips providers with streamlined workflows, error reduction, and expedited reimbursements, enhancing patient care and operational excellence in the healthcare sector.
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Benefits

Resource Optimization

Automated claims processes allow for resources allocation to more strategic, complex tasks rather than routine processes to improve staff productivity.

Enhanced Processing Efficiency

Streamlined claim processing reduces bottlenecks and processing times, resulting in significant cost savings and decreases in denied and rejected claims.

Faster Claim Settlement

Automated processes can quicken claims settlement and enhance cash flows through expedited claims processing.

Solution capabilities

Advanced AI/Generative AI

Simplify document recognition, extraction, data review and comparisons, decision-making, and workflow design with AI and GAI. 

Case Management

Manage multiple documents, content, automated and human assisted tasks, and detect fraud more efficiently.

Task Automation

Complete repetitive tasks for data aggregation, data comparison, and keystroke automation for faster, more accurate review.

Dynamic Workflows

Easily adapt workflows based on changing conditions.

Multi-Channel Capture

Manage and process content for any source, any format.

Customer Engagement

Enhance customer experiences through greater visibility and self-service interactions.

FAQ
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Yes, TotalAgility document libraries have pretrained extraction models available out-of-the-box for healthcare specific documents such as UB04, CMS 1500 and other forms
Yes, the solution provide a strong emphasis on enabling compliance with healthcare regulations including HIPAA, etc. for customers
100s of pre-built business rules (CLAIMS- Automate Medical Claims Processing for TotalAgility) to enforce the specifications that govern the medical forms and EDI
Yes, there are ready-to-implement claims automation solution bundles for high impact areas, like - CLAIMS Automate Medical Claims Processing for TotalAgility
Yes, the platform incorporates analytics as part of its offering and have the option to enhance it with additional features and capabilities for deeper insights. The solution also allows organizations to create new reports and dashboards based on a library of best practices metrics, and features pre-built content for capture-based processes
The solution offers robust integration capabilities to connect with all major EHR systems, integration engine can ingest data from the EHR in real-time or via batch interfaces to streamline workflow and data capture. This eliminates the need for redundant data entry and ensures information flows seamlessly between systems
Yes, the solution provides integrated tools which empowers developers and business users to create custom solutions for desired automation use cases without dependency on vendors