Processes
Process intake of claims
How process intake of claims are reshaped as AGI capability advances.
ProcessesProcess intake of claims
Business-as-Code
Read as an executable program — the work decomposed into Code, Generative, Agentic, and Human.
Process intake of claims sits inside a larger value-flow — 1 parent structure it composes into. The hierarchy is grounding, not the story: it tells you which aggregate exposure Process intake of claims inherits.
Where Process intake of claims sits
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How the work flows
Trigger: A healthcare provider or policyholder submits a claim for medical services via electronic data interchange, web portal, or paper mail.
- Receive electronic and paper claim submissions
- Scan and digitize paper claims via optical character recognition
- Validate basic claim data against member and provider databases
- Identify and flag missing or malformed information
- Assign a unique claim control number
- Route the validated claim to the adjudication queue
Outcome: The claim is digitized, validated for basic completeness, assigned a tracking number, and routed to the adjudication system.
Measured by
First-Pass Acceptance RateIntake Cycle TimeElectronic Intake PercentageIntake Exception Rate