Long Sales Conversion Time. Miss outs on timely tender submission resulting in loss of Revenue.
Average Time taken to close sales 5-7 days.
MedML revolutionizes the AI/ML landscape by providing pre-built engines focused on healthcare and standardizing the AI market in healthcare across various regions.
With our fully automated AI module, get predictions in just minutes. No technical hassles: simply select your AI application, upload your data, and access instant recommendations.
With clear data visualizations and suggestive notifications, we help you make informed decisions and significantly increase your returns.
You'll gain insights on reducing losses, identifying problematic provider services, and detecting system abuses by physicians, among other aspects.
We offer a curated experience that allows you to quickly access the AI solutions you need as a payer.
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Existing Ancestral Health and Life Group Underwriting and Policy Issuance Process
Long Sales Conversion Time. Miss outs on timely tender submission resulting in loss of Revenue.
Average Time taken to close sales 5-7 days.
Underwriting team uses the initial request and fill manually a rater tool in excel or a specific software for Portfolio/Book Premium Projections
Underwriting team gets approval on mails for each quotation price confirmation
In case the client finds issues in affordability or may ask for a different benefit option then underwriting team needs to perform Step 2 to Step 4 again
Underwriting team uses the initial request and fill manually a rater tool in excel or a specific software for Portfolio/Book Premium Projections
Underwriting team pulls claims experience data from the system depending upon the requirements of the clients benefits in order to calculate premium from claims experience
Underwriting team gets approval on mails for each quotation price confirmation
Mail the client for final confirmation on the price and policy issuance.
In case the client finds issues in affordability or may ask for a different benefit option then underwriting team needs to perform Step 2 to Step 4 again
Policy pdfs are created manually and mailed to the client. The benefit and member information
Underwriting team pulls claims experience data from the system depending upon the requirements of the clients benefits in order to calculate premium from claims experience
Mail the client for final confirmation on the price and policy issuance.
Policy pdfs are created manually and mailed to the client. The benefit and member information
Impact - 85% REDUCTION in UW Process Time FASTER Quotation release! Reduction in miss out of tenders due to team bandwidth or long process time. Hence higher revenue and sales conversions.
Tell us your needs or Drop Desired Benefits Structure (as a group or individual or broker)
Tell us your budget range
Our Al does the Magic!! Run Numerous deep pricing algorithms
If the desired coverage price meets your budget, our AI will provide you with a link to purchase the policy instantly!
Otherwise our AI allocates your case to Human Intelligence to share most suitable plan option with payment link as soon as possible.
Policy Terms and Benefits AUTOFILL
CONFIGURABLE AI-POWERED DEEP RISK ASSESSMENT Pricing Calculator
CUSTOMIZABLE Policy Template for CLIENT VIEW to make various combinations of plans or benefit structures to meet the affordability.
CONFIGURABLE Temporary EXTERNAL Link for client to make payment and view the price options.
Quotation Hierarchical Management & Approval Submission
Quotation Archive and Management
Quotation History View Dashboard
Customizable Policy PDF output generation
Data Recording APIs updating policy conditions in database
Alerts on Loss Ratio, Monitoring & Suggestion To control, Generative AI Assisting on underwriting Decisions
Generative AI indicating the reason for high Loos Ratio, which policy, which provider, which employee, etc. In case medical insurance business this can help in timely SOP roll outs to Provider for efficient Provider Management and Claim Payouts.
Existing Ancestral Claims Submission and Claims Adjudication Process
Provider submits medical preapprovals or claims.
Policy Adjudication is performed by the adjudicator, manually or via a rule-based system.
Manual Adjudication is performed along with data entry checks
Provider submits medical preapprovals or claims.
Client/Policyholder submits life claims.
Policy Adjudication is performed by the adjudicator, manually or via a rule-based system.
Medical Adjudication is performed for medical claims. Claims authenticity is checked for medical or life claims
Manual Adjudication is performed along with data entry checks
Client/Policyholder submits life claims.
Medical Adjudication is performed for medical claims. Claims authenticity is checked for medical or life claims
90% Reduction in process time. Hence faster claims submission and adjudication. 10-11% Reduction in the Net Payout due to lack of identification of unnecessary billings.
File a claim (as a policyholder or member)
Submit Proofs
Our Al runs intense algorithms to check claim authenticity
If all seems good our Al will make the payment in seconds
Otherwise, our Al allocates your case to Human Intelligence to settle your claims ASAP
Claim Adjudication Automation
Aberrant / Egregious Billing : Pre & Post Adjudication
Provider, Doctor, Civil, Family Billing Behaviour Monitoring
Whistleblowing and FWAE Tracking- Internal communication digitization
MedML AI Alerts identifying discrepancies
Interconnection AI applications Preapprovals and Provider Claims Analytics
Data Recording APIs updating CLAIMS, BATCH, MASTER BATCH, SERVICE DATA
Generative AI assisting Adjudication Team on Clinical Rules
Alerts on major upload on batches check for Consistency Sense Checks, System Alerts
Auto-Fill on Provider Claim Submission Portal
Existing Ancestral Provider Empanelment Process
Provider Proposes the Rate for each of the services over mail
Network Pricing team manually computes the impact on Net Payout (increase) due to revised or new provider rates.
Once the Provider Negotiations are done, Team manually uploads the rate card into the system.
Provider Proposes the Rate for each of the services over mail
Network Pricing team compute in excel the rates of benchmark providers (similar vicinity and cost)
Network Pricing team manually computes the impact on Net Payout (increase) due to revised or new provider rates.
Network Pricing Team get approvals from the management on the proposed rate card to ensure the increase in claim payout is within the acceptable standards.
Once the Provider Negotiations are done, Team manually uploads the rate card into the system.
In case of multiple negotiations between Provider and Insurer, the Team performs Steps 1-4 steps again until the desired negotiations are met.
Network Pricing team compute in excel the rates of benchmark providers (similar vicinity and cost)
Network Pricing Team get approvals from the management on the proposed rate card to ensure the increase in claim payout is within the acceptable standards.
In case of multiple negotiations between Provider and Insurer, the Team performs Steps 1-4 steps again until the desired negotiations are met.
90% REDUCTION in Process Time and reduced risk of errors in benchmarking.
Submit Service Rate Card (as a provider)
Our Al benchmark rates with peer providers and acceptable net impact!
Our Al will suggest areas of peer excellence, roll-out custom SOPs in seconds that help in informed Provider Management
If all seems good our AI will Empanel Provider & Revise Contract in seconds.
Otherwise, our AI allocates your case to Human Intelligence to discuss on proposal as soon as possible.
Automated AI-Powered Provider Benchmarking Calculator
DEEP NLP Driven CPT - Provider Treatment Standardization
Impact analysis on claims ratio for various price recommendations/changes
Price/Discount Recommendation Management and Approval Submission
AI Alerts identifying discrepancies.
Interconnection of Provider Empanelment and UW AI Applications
Data Recording APIs updating PRICE LIST data.
Generative AI assisting Network Team on Rates Negotiation
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