AI Payor Solution – Claims Acumen

Health Insurance Payors provide patients with the health insurance coverage needed to receive necessary health care services. The healthcare provider submits a medical claim to a payor to receive reimbursement for the services rendered to the patients. This claim has information about that incident otherwise known as an encounter which can be at a physician office, outpatient facility or an inpatient setting.

The medical claims data set can be used to generate helpful insights about usage of services, frequency of such services, what is paid, denied or rejected.