결제자용 비정형 컨텐츠의 AI 기반 요약

This IDC Perspective takes a deep dive into content summarization of unstructured data and artificial intelligence (AI) for payers. Using AI to use platforms that can take in, study, and learn from data, refine judgments, and generate intelligent insight reduces the need for expensive human data analysts.Pulling together unstructured data for today's AI is no overnight task. Mergers and acquisitions have resulted in fragmented IT architectures. Important documents have been lost to view, locked in offline proprietary file types."Within the AI potential, content summarization holds the most short-term promise for payers. Content summarization with AI in health insurance is quickly driving improvements and changing the relationship between payers, providers, and members. It helps to enhance and streamline the member/patient experience and makes internal operations easier," says Jeff Rivkin, research director, Payer IT Strategies at IDC Health Insights.

Executive Snapshot

Situation Overview

• Use Case: Eligibility and Benefits Verification
• Use Case: Medical Records/Service Clinical Review
  • Sub-Use Case: Identifying Under-Documented Social Determinants of Health
  • Sub-Use Case: Fraud Detection/Payment Integrity
  • Sub-Use Case: Prior Authorization
• Use Case: Explanation of Benefits
• Use Case: Radiological Images
• Use Case: Member/Provider Contact Center Recordings and Chatbot Chat Summarization
• Use Case: Claims Coding
• Use Case: Claims Management/Settlement (Payer Side)
• Use Case: Claims Management/Settlement (Provider Side)
• Use Case: Claims Denial Resolution
• Use Case: Intelligent Content Search and Summarization of Reference Data - Finding Information from Public and Private Data Sources Including the Patient Record

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• Synopsis