CERIS Announces Innovations in Artificial Intelligence and Machine Learning That Improve Payment Integrity

Rhea-AI Summary

CorVel's CERIS leverages generative AI and machine learning to enhance payment integrity in medical claims, improving efficiency and accuracy. The company pioneers the use of AI and ML to automate tasks, identify fraud or errors, interpret medical language, and summarize data. This advancement allows for increased throughput, accuracy, faster turnaround time, and improved savings ratios for clients, ultimately leading to higher job satisfaction and improved outcomes.

Positive

• CERIS leads the industry in leveraging AI and ML for payment integrity
• Generative AI and machine learning improve productivity and savings
• Increased throughput, accuracy, faster turnaround time, and improved savings ratios benefit CERIS clients
• Technology elevates the efforts of professional staff and improves outcomes delivered to clients

Negative

• None.

Generative AI advances claim efficiency and accuracy

FORT WORTH, Texas, Nov. 14, 2023 (GLOBE NEWSWIRE) -- Advancements in artificial intelligence (AI) and machine learning (ML) are significantly improving results and efficiencies for payment integrity in medical claims, according to CERIS, a CorVel company.

“CERIS leads the industry in leveraging AI and ML to automate tasks for greater efficiency and accuracy, to find patterns that may indicate fraud or systemic errors, to interpret medical language, and to summarize large amounts of information into actionable data,” said Steve Sutherland, Senior Vice President of Information Systems for CERIS, a Fort Worth-based company that has pioneered the use of this technology for payment integrity.

Sutherland notes, “Now, generative AI and machine learning are taking productivity and savings even further. For example, by efficiently using machine learning, we can more effectively identify claim combinations with high probability of upcoding, flagging them for review by the claim professionals. We can summarize medical documents, extract keywords, answer specific questions, and bring often overlooked items to the reviewer's attention. As a result, payers can more efficiently pay medical bills that are accurate and appropriate for the claim.”

Already, optical character recognition (OCR) and document extraction have increased throughput significantly. Additional benefits to CERIS clients include improved accuracy, faster turnaround time, and increased savings ratios.

Incorporating this technology also allows review teams to spend less time on tedious manual analysis so that they can focus on higher-value, more enriching work that better serves client needs. By making their work more rewarding and meaningful, valuable employees have higher job satisfaction and are more engaged, improving employee retention. CERIS’ leadership in technology elevates the efforts of professional staff and improves the outcomes delivered to clients.

Speed and precision are essential for maintaining payment integrity in healthcare, where payers have a responsibility to promptly and accurately reimburse providers, thus avoiding time-consuming efforts to recover erroneous payments. Prepayment review is becoming the norm – making it even more important to determine if a bill is accurate in a timely manner. Utilizing these new technologies improves the process and the experience of payers and providers.

About CERIS

CERIS, a leader in both prospective and retrospective claims review and repricing, combines clinical expertise and cost containment solutions to ensure the accuracy and transparency in healthcare payments. Accuracy and validation services include itemization review, DRG validation, facility repricing, contract and policy applications, review of implants and devices, and primary payer cost avoidance. Its universal chargemaster contains billions of charge items from more than 97% of the nation’s hospitals, helping to ensure the accuracy and objectivity of each claim review.

Contact: Melissa Storan
Phone: 949-851-1473
www.corvel.com

What technology does CERIS use to enhance payment integrity in medical claims?

CERIS leverages generative AI and machine learning to automate tasks, identify fraud or errors, interpret medical language, and summarize data.

What benefits do CERIS clients receive from the use of generative AI and machine learning?

Clients benefit from increased throughput, accuracy, faster turnaround time, and improved savings ratios.

How does the use of new technologies improve the experience of payers and providers?

Utilizing new technologies improves the process and the experience of payers and providers by allowing for timely and accurate reimbursement, ultimately avoiding time-consuming efforts to recover erroneous payments.