ICD Classification
Automated ICD Code Extraction and Classification for Precise Claims Adjudication and Fraud Prevention
Description
Introduction:
Manually extracting ICD codes from claims documents is time-consuming and error-prone. The ICD Classification module automates this process, improving accuracy and speeding up claims adjudication.
Overview:
This module automatically extracts and classifies ICD codes from complex claims documents, providing condition data that streamlines the rule-setting process for faster, error-free claims decisions. It ensures accurate condition identification for adjudication, policy exclusions, and fraud detection. It helps assessors make informed decisions quickly, streamlining claims processing and fraud prevention.
Benefits:
The ICD Classification module improves the accuracy and speed of claims adjudication by automating the extraction of condition data from claims documents. This not only accelerates decision-making but also strengthens fraud detection, ensuring claims are processed in compliance with policy terms.
Features
This solution automates ICD code extraction and classification from claims documents, enhancing adjudication accuracy while supporting fraud detection, ensuring compliance with policy terms.
Features and Capabilities:
ICD Code Extraction: Automatically identifies and extracts ICD codes from claims documents for accurate data capture.
Condition Classification: Classifies medical conditions to determine policy inclusions, exclusions, and benefit limits.
Fraud Detection Support: Flags unreasonable trends in claimed conditions to prevent fraudulent claims.
ICD Extraction Engine: Uses advanced document processing techniques to capture medical condition data.
Real-Time Classification: Instantly classifies conditions to aid in claims adjudication, improving decision speed.
Ruleset Integration: Works with adjudication rules to ensure compliance with policy terms, such as exclusions and waiting periods.
Fraud Scoring Integration: Collaborates with fraud detection tools to ensure claims integrity and prevent misuse.
Resources
Key Information
Platform Modules:
Neutrinos Predictive AI Hub: Deploy and manage predictive models to enable real-time, data-driven decisions across rules, case management & workflows.
Version: 24.09
Neutrinos Document and Text AI Hub: Automate and enhance document processing and text analysis to unlock valuable insights from unstructured data.
Version: 24.05
Neutrinos Business Rules Engine: Empower your processes with intelligent, real-time decision automation at scale. Accelerate decision-making and policy enforcement with intuitive rule automation.
Version: 24.07
Neutrinos Dev-Ops and System Management: Gain full visibility into your applications and systems to quickly spot issues, optimize performance, and keep everything running smoothly.
Version: 24.02
Additional References
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