AI-Based Summarization of Unstructured Content for Payers

Executive Snapshot

• Figure: Executive Snapshot: AI-Based Summarization of Unstructured Content for Payers

Situation Overview

• Use Case: Eligibility and Benefits Verification

• Use Case: Medical Records/Service Clinical Review

• Sub–Use Case: Identifying Under-Documented Social Determinants of Health

• Sub–Use Case: Fraud Detection/Payment Integrity

• Sub–Use Case: Prior Authorization

• Use Case: Explanation of Benefits

• Use Case: Radiological Images

• Use Case: Member/Provider Contact Center Recordings and Chatbot Chat Summarization

• Use Case: Claims Coding

• Use Case: Claims Management/Settlement (Payer Side)

• Use Case: Claims Management/Settlement (Provider Side)

• Use Case: Claims Denial Resolution

• Use Case: Intelligent Content Search and Summarization of Reference Data — Finding Information from Public and Private Data Sources Including the Patient Record

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• Related Research

• Synopsis