Processes

Enter interactive claims into claims system

How enter interactive claims into claims system are reshaped as AGI capability advances.

ProcessesEnter interactive claims into claims system
Enter interactive claims into claims system — illustrated

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How the work flows

Trigger: A provider, billing service, or member submits a health insurance claim interactively via a web portal or direct application interface.

  1. Receive interactive claim submission via web portal or direct interface
  2. Validate claimant identity, provider credentials, and active policy status
  3. Check input fields for required diagnosis and procedure codes
  4. Prompt the submitter in real-time to correct missing or invalid data
  5. Map the validated claim payload into the core claims system
  6. Generate and return a unique claim tracking number to the submitter

Outcome: The claim data is validated for completeness and successfully logged into the core claims administration system for adjudication.

Measured by

Intake Cycle TimeFirst-Pass Acceptance RateCost Per Claim EnteredInteractive Submission Error Rate