Google Cloud today announced a new AI-enabled Claims Acceleration Suite that streamlines the pre-approval and processing of health insurance claims. The solution, leveraging the newly created Claims Data Activator, will help healthcare plans and providers reduce administrative burden and costs by transforming unstructured data into structured data, enabling professionals to make faster, more informed decisions that improve patient care. AI-enabled pre-authorization is available to Google Cloud customers today, and additional Claims Acceleration Suite features will be available later in the year.
According to the Centers for Medicare & Medicaid Services (CMS), the current pre-approval process takes an average of 10 days. During this process, healthcare providers review their patients’ coverage to determine whether a recommended procedure, drug, or device requires prior approval and submit the necessary supporting information. The health plan then receives and organizes this information for review by their doctors. The purpose of this process is to manage quality and ensure members receive safe and necessary care. This results in both providers and payers investing significant resources due to the manual administrative intervention required. With advanced technologies, a previously highly manual process can be modernized. Information shared in unstructured formats, such as PDF documents converted from faxes, images, and other health record data can be converted into a structured format. Technology can significantly reduce time-consuming administrative pre-approval work and accelerate time to decision and access to care. Prior approval contributes $25 billion to the cost of care annually in the United States, and introducing more automation could save $454 million per year (Council for Affordable Quality Healthcare estimate) and resources for providers and unleash health plans to further advance their efforts toward more direct care and care management programs.
“It’s time to modernize the pre-approval process, leverage current technologies to improve access to healthcare, and extract value to better serve those in our communities,” said Amy Waldron, Director, Global Health Plans Strategy and Solutions, Google Cloud. “Our Claims Acceleration Suite is a great example of how Google Cloud’s AI is driving much-needed operational efficiencies by reducing the manual administrative burden for providers, allowing payers to focus their time on clinical assessment and verification, increasing the speed of treatment improve and add value to a process without disrupting the assessor’s role in claims decisions.”
In addition to the business benefits of AI-powered pre-approval, CMS is actively working to create an environment for the market to develop new solutions with its updated regulatory requirements related to interoperability and pre-approval, including leveraging Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) Application Programming Interface (API). Google’s Claims Acceleration Suite will help healthcare plans meet current and proposed requirements and will enable healthcare plans to derive greater value from data as a strategic advantage to enhance the provider and member experience.
