PAYER USE CASE

Automating Claims Adjudication

Reducing manual review touchpoints with Clinical NLP

The Challenge

A national payer was struggling with a backlog of complex claims requiring clinical review. Manual nurses could only process 3 claims per hour.

The Solution

We deployed the ADI RevCycle Suite to ingest medical records and automatically map them to policy criteria, flagging only exceptions for human review.

Pilot Results

~30%

Potential reduction in manual review volume

2x

Demonstrated increase in processing speed

95%

Validation of clinical data extraction accuracy

Validated use cases reflect proof-of-concept and pre-pilot implementations. Results may vary based on data quality and integration scope.