Pega Marketplace
ClaimScribe
Transform Health Claims Processing with the power of Generative AI to summarize medical reports, scans, etc. to reduce manual errors and claim processing time.
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Overview
Built using Pega Gen AI, extended by integrating with Google Gemini Pro Vision, our solution ClaimScribe acts as an intelligent assistant to Claims Assessors to review medical reports, scans and prescriptions by generating summary of documents uploaded, providing a diagnosis and prognosis of the ailment/condition found in the documents, along with treatment suggestions. This AI analysis provides a fantastic aid to the claim assessor to quickly decide on whether the claim needs to be approved or denied. It helps to provide all the information the claim assessor needs to decide on the next actions on click of a button.
Key Features
- Get summary of all medical reports uploaded by the claim assessor
- Overall consolidated summary of all the reports together provides a holistic view of the problem statement, the treatment pursued and the outcome of the treatment
- Segregation done based on whether medical report is a scanned image like X-Ray / CT scans or textual reports like blood reports etc.
- Each alternate treatment is supported by the estimated cost associated for the claim assessor to determine whether the actual treatment procedure is most optimum
- A dynamically generated table provides all the alternate treatment / regime options which could have been followed
- The claim assessor is also able to edit the AI generated analysis in case inconsistencies are noticed
Resources
Partner Name
Maantic
Tags
- Pega Products: Pega Platform
- Industry: Insurance
- Product Capability: Artificial Intelligence Case Management Workflow Automation Enterprise Application Development Data Integration Artificial Intelligence Case Management Workflow Automation Enterprise Application Development Data Integration
- Pega Version compatibility: '23
- Geography: Americas Asia Pacific EMEA
Offering Type
Component