The healthcare insurance industry is currently facing a lot of setbacks, particularly in making sure that valid claims are being approved. A lot of claims are being rejected early on in the patient registration phase, meaning that errors in reporting basic information such as the insurance payer can completely invalidate the claim from being processed. These denied claims are amounting to $71 billion a year, which is a third of all healthcare administrative costs per year. This is why health insurance card capture with AI is so important.

AI Versus Human Error

A lot of these errors are caused by human error. There is a lot of intricacy in insurance processing, and it depends largely on human knowledge to find and enter the correct data. Insurance cards frequently omit important information, which means that staff has to have a lot of domain expertise to recognize the claims payerID where the claims should be submitted, the electronic eligibility payerID, and the insurance payer. More complexity is introduced by the stringent rules that different insurance providers put on submitting the correct state, municipal, and ZIP claim localities.

The current technology being used to capture information is faulty as well. Optical character recognition (OCR) and other existing digital intake systems are used to help capture information quickly. However, they can’t identify information that isn’t already printed on an insurance card, which is not helpful for entering the information that is already difficult for the employees to find. They also can’t process digital insurance cards, which are gaining a lot of popularity among patients.


The development of AI could potentially solve these issues. AI software is able to quickly validate data after being trained on large datasets with a variety of insurance plan types and payers. AI is able to find and validate data in as little as five seconds, which is a massive improvement from the five to fifteen minutes needed for manual processing. Integrating AI technologies could lead to significant cost savings and an error-free system. It seems that achieving these revolutionary advantages will depend on the industry’s decision to embrace and develop AI-driven solutions.

The Smarter Way to Capture, Verify, and Process Insurance with an AI-Powered Solution
Source: OrbitHC