Automating Claims Adjudication for Health Insurers

Health insurance companies adjudicate claims submitted to them in the form of medical codes. Armies of claims adjudicators  employed by health insurers must review these codes and quickly decide if they are appropriately mapped  to one another. This often leads to variation in decision making between adjudicators, poor decisions, and costs to insurers from undetected fraud and abuse. Keeping staff up to date with the latest medical evidence is especially difficult given that over 400,000 new medical articles are published each year.

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Isocortex Medical is solving these problems by powering the automation of health Insurance claims adjudication, using advanced Artificial Intelligence. 

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Our Galen-Rx, evidence-based database uses the latest medical evidence to map international coding systems like ICD-10-CM and ICD-10-AM diagnosis codes to their corresponding CPT procedure codes, CPT laboratory codes, regional Drug codes and billing codes.

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The Galen-Rx database is maintained automatically using artificially-intelligent systems that review the latest medical evidence and clinical guidelines to ensure the database is always up to date, and in line with the changing medical evidence.

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Using Galen-Rx, health insurers can automate the adjudication of claims submitted by providers and reduce the burden of administrative and operational costs associated with claims management. Allowing them to make better decisions, offer lower premiums to members, and scale more efficiently.

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