September 15, 2022

Can Insurance Claims be Automated from Discharge Summary?

A discharge summary is a necessary insurance claim form that includes essential details regarding a patient's hospital stay, including the patient’s illness and the medical operation done on him. However, this task can be quite laborious. To learn what VisionERA can do read the article ahead…

Following COVID19, there has been a significant change in how firms operate, and this phenomenon is pervasive. Insurance firms are no exception; businesses that have excelled over the past several years are now looking to adopt and implement digital technologies to transform their operations and improve efficiency, resource optimization, and customer experience. Claims is the only feature that is essential to the insurance industry. This one has the power to create or break a company. Claims management is a delicate area that insurance firms are working to simplify and streamline. Unacceptable delays in the claims request verification process, the authentication of the submitted supporting papers, and other factors might result in lost clients and a corresponding decline in business. 

Increasing efficiency, accelerating claims processing, and raising customer satisfaction levels are the goals of insurers’ goals since they will spur corporate expansion. Therefore, seamless claims processing that overcomes the difficulties as urgently required. We've written a few blog pieces in the past about automating document workflow, intelligent document processing (IDP), and the need for IDP adoption in the insurance industry. 

Check out this blog for more detail.

Streamlining Intelligent Processes Automation in Insurance 

Healthcare firms are giving digital transformation initiatives top priority in light of the explosive situation that looms ahead. The competition and rising customer expectations are placing pressure on insurers. The limits in the fundamental systems that prevent insurers from releasing new products, innovating, and providing cutting-edge technology capabilities are one of the key reasons for these difficulties. Similar to this, there is a great demand for automation because it would hasten the customer onboarding process, cut down on time and expense associated with claims administration, and create new potential for upselling.  Automation must be implemented into the techniques since it is the only means of achieving quick market-time, continuous innovation, accurate data, understanding client profiles, and simplifying the claims process.

The insurance industry is infamous for its poor customer service. Not specifically in any nation, though. Many tech behemoths have worked extremely hard over the past few years to become the epicenter of insurance innovation. Consider this as just one illustration: WeSure, the insurance platform that grew out of the messaging app WeChat, celebrated its second birthday with more than 55 million subscribers. Accordingly, the largest issue facing insurers today is not just digitizing their operations but also expanding beyond their current range of services and perhaps fusing insurance with other financial services. Insurance businesses use AI, IoT, and big data to change the sector in order to compete.

The most crucial measures for insurance companies are the customer satisfaction score (CSAT) and net promoter score (NPS). However, the US significantly lags because insurers cannot meet demand as other businesses have grown. Let's examine how technology may bring revolutionary change to expenses, operations, and customer experience as the claim filing process significantly impacts customer happiness. 

Why are Claims Automated? 

Why do insurance businesses first struggle with automation and digitization? If we set aside the typical causes, such as staff resistance to change or a lack of financial or technological resources, there is one significant factor that derives from the nature of insurance: insurance processes are frequently too variable and ad hoc to be easily incorporated into the digital workflow. 

For instance, claims data must be received and analyzed with high accuracy even while it is available in various formats (pictures, handwritten notes, voice memos). It is provided over multiple channels (email, document attachments, phone calls, chats). And when it comes to decision-making, it's frequently more complex than a ready-made system can manage; it necessitates knowing the specifics of each instance. 

Does this imply that the insurance sector can never be automated and that human involvement is required at every step of the procedure? Obviously not. However, it does require more sophisticated strategies, such as AI, machine learning, and ML-based robotic process automation, that replicate human perception and judgment.

For decades, organizations have been processing physical documents using optical character recognition (OCR). OCR essentially transforms handwritten and printed text into machine-encoded text. OCR uses manually made templates and can cause slight errors in important information, such as someone's name, the date, or the price, making the digitized copy unusable even though it delivers incredibly accurate results for typed text. This requires manual inspection of files generated by conventional OCR, which is very different from automation

Intelligent Document Processing (IDP) 

Intelligent Document Processing, also known as Cognitive Document Processing (CDP) or ML OCR, is a cutting-edge alternative to OCR that uses AI to enhance document quality, classify documents, and extract unstructured data that may be transformed into valuable, structured data. 

IDP is frequently used in robotic process automation, enabling predetermined workflows to automate various basic business processes. For instance, bot utilizing IDP will be able to evaluate customer-sent documents, extract pertinent information from text and media, and submit it for additional processing, such as manual review or fraud detection algorithms, all without requiring human involvement. 

How to use  IDP?

Intelligent Document Processing systems have the advantage of not having to be specifically aimed at the insurance industry and having more supplier possibilities. You have two implementation options, depending on where you are.  Use an RPA system that is ML-based. You will only need to invest minimal time in the integration process if you choose solutions like UiPath or Automation Anywhere, which have their own cognitive document processing capabilities. Consider suppliers like VisionERA if you want to update your current traditional OCR or add to your current RPA efforts.

Pre-approval is the Initial Action

The first step in making a claim is getting pre-authorization from the insurance company. You and the physician treating you must fill out the pre-authorization form. Your doctor will fill in the treatment information, while you are responsible for providing personal and insurance policy information. The paperwork is then submitted to the hospital's billing department, which will estimate the cost before sending the documents to your insurance provider. After reviewing these records, the insurer pre-approves the claim. 

Pre-authorization typically indicates that the insurer has approved an initial sum and that the claim will be paid pending receipt of the hospital's final invoice. It's crucial to realize that a pre-authorization is merely an acknowledgment of the claim, not a promise that it will be resolved. Even if your claim is pre-authorized, you might later be required to submit more paperwork, and approval might take some time. If it's an unplanned admission, the hospital might ask you for a deposit that will be returned later. Because of the possibility that your admission will be unexpected, you may not have enough time to complete the pre-authorization process. 

On the Day of Discharge 

Pre-authorization is being completed more quickly, however, claims settlement at the time of discharge may be a time-consuming process. Insurance will want the discharge summary, which can take some time to process the claim. The insurance will review the hospital expenses after receiving the discharge report and bills before paying them.

IoT and Telematics for Improved Data Accuracy 

Insurance companies have access to information from internet-connected equipment like water sensors, smoke alarms, and in-car sensors.  Over 14,000 water damage claims are made by homeowners in the US every day, with costs averaging up to $15,000. In addition to reducing the number of shares by leveraging alerts from sensors to stop this damage, data from these sensors can also be used to build predictive analytics models that speed up the adjudication of such claims. 

What are ICD-10 CM and ICD-PS?

The term "ICD-10" refers to the tenth edition of the International Classification of Diseases, a system of medical coding developed primarily by the World Health Organization (WHO) to classify medical conditions by groups of related illnesses under which more specific illnesses are listed, tying subtle diseases to more extensive morbidities. ICD-10 is used in numerous nations, each of which has changed it to fit with its particular healthcare system. ICD-10-CM and ICD-10-PCS are the two medical code sets that make up the US version of ICD-10, which was developed by the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). 

The International Classification of Diseases, Tenth Revision, Procedure Coding System is called ICD-10-PCS. ICD-10-PCS is a procedural classification system for medical codes, as suggested by its name. It is employed in healthcare facilities to document inpatient operations. 

The International Classification of Diseases, Tenth Revision, Clinical Modification is known as ICD-10-CM. ICD-10-CM is a standardized classification system of diagnosis codes representing conditions and diseases, related health problems, abnormal findings, signs and symptoms, injuries, external causes of injuries and illnesses, and social circumstances. It is used for medical claim reporting in all healthcare settings. 

ICD-10-CM vs. ICD-10-PCS: Differences 

On October 1, 2015, the ICD-10-CM and ICD-10-PCS standards for reporting medical claims went into effect. The two code sets, however, are very different. The main differences are: 

  • The diagnosis code system used in all healthcare contexts is ICD-10-CM. 
  • Procedure code set ICD-10-PCS is only utilized in hospital inpatient settings. 
  • In the US, ICD-10-CM and ICD-10 are both used equally. 
  • This linguistic tendency highlights the differences between CM and PCS because every medical coder uses ICD-10-CM as the only accepted format for reporting diagnoses in healthcare settings. 
  • The PCS code set is one of two procedural coding systems. ICD-10-PCS is only utilized in hospital inpatient healthcare settings, in contrast to CPT.

Not going into much detail, the central crux behind the argument is that automating the entire discharge procedure can ease the burden of not only the staff but also for the person at the receiving end.

VisionERA's Role in Automating Insurance Claims 

In conclusion, an organization's ability to successfully onboard new personnel is closely related to its long-term performance. Although there are numerous ways to assist a new worker in adjusting, automating the employee onboarding process is one of the best ways to boost productivity. It can be extremely beneficial for visionERA to play a part in automating the onboarding of physicians. VisionERA is a smart, intelligent document processing platform that uses AI to scan, classify, and selectively extract key information from documents for companies of all sizes. Leveraging on machine learning, computer vision and AI technology thats is independent of any third parties we offer an end-to-end sophisticated automation for all your document needs. Embedded with capabilities like HI-AI collaboration, a continuous learning mechanism, we offer a unique DIY platform that can help you automate complex manual tasks at the click of a button. 


By leveraging VisionERA, you may put an end to laborious, error-prone manual physician onboarding procedures. The program's highly developed platform makes it simple to process multiple documents at once. 

With genuine medical records as its training data, VisionERA's AI has been honed to produce reliable findings. Digital health records will allow you to spend more time with patients. 

To arrange a time for a free demonstration of VisionERA, click the call to action button below. 


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