Use Cases

US Public Sector Medicare & Medicaid Claims Processing

Every year, public sector agencies ingest millions of documents related to Medicare and Medicaid claims, including claims forms and supporting documentation. Highly accurate data must be extracted from these documents to automate downstream claims processes ranging from eligibility and enrollment, performing redetermination for constituents, to calculating provider payments. Forms, such as HCFA / CMS1500 forms, UB-04 or CMS 1450 forms, along with non-standard documents related to income verification, identity verification, and unstructured medical records have historically required significant manual intervention to extract the data necessary to process the claim.

The Hyperscience Platform is used to enhance Medicare and Medicaid claims processes by automating data extraction from structured and unstructured claims documents. By leveraging a configurable approach to Machine Learning, Hyperscience automatically classifies, extracts, and enriches high-quality data from any document. This includes handwritten and machine-printed forms, semi- and unstructured documents, skewed, low-quality scans and images, and more. Hyperscience exposes flexible, standards-based integrations with industry-leading process automation technologies to work seamlessly within existing environments.

Federal and state agencies are using Hyperscience to reduce backlogs, increase data accuracy, improve response times, minimize risks, and deliver on their digitization aspirations—now it’s time for your department to do the same.

Enable your agency to:

Achieve Auto-Adjudication

Process constituent data accurately and without extra steps by converting handwritten and machine printed text into actionable data that can be used to drive faster, more reliable downstream processing.

Boost Constituent and Provider Satisfaction

Upgrade the efficiency of your agency, expediting claims and enrollment to keep both constituents and medical care providers satisfied and stress-free. Better satisfied constituents are both 9 times more likely to trust the agency providing them service and 9 times more likely to agree an agency is delivering on its mission.

Improve Organizational Agility

Scale automation to improve operations across your agency. With the modularity and customization the Hyperscience Platform provides, you can leverage the power of Machine Learning in the ways that best improve the lives of your employees and constituents.

Reallocate Your Workforce to Serve Your Mission

By automating claims data extraction and data entry, you can train and upskill your employees to focus on higher-value work. Our customers have upskilled their employees to take on duties such as claim adjudication, call center support, and more—enabling them to achieve a better customer experience and more efficient operations.

Automate Safely and Securely

The Hyperscience Platform is deployed on-premise, within your firewall, and easily integrates with systems that you own and control. There are no dependencies on any underlying technologies hosted by a third-party. Your data never leaves your environment.

Medicare Claims Processing

Millions of Americans depend on their Medicare coverage for significant and life-saving healthcare. Despite the essentiality of this social service, volume has made it difficult for the federal government to keep up with claims.

Medicare claims processing can be expedited with the use of automation to simplify and streamline the way constituent data is extracted and enriched from UB-04 or CMS 1450 forms—leading your federal employees to experience the power of higher quality data and streamlined operations.

With experience with federal government agencies and the customizability required to scale in a complex security environment, the Hyperscience Platform is the proven, secure, and effective way to apply the power of Machine Learning into the Medicare claims processing workflow.

Medicaid Claims Processing

Over 80 million Americans are currently Medicaid members. Each one of them rely on state and local agencies to process their claims for vital medical services. A delay in claims processing could result in unwarranted financial stress or delayed treatment that individuals are rightfully covered under Medicaid to receive.

As the pandemic increased enrollment volumes, both due to changes in financial circumstances and extended eligibility due to the Public Health Emergency (PHE), local agencies became inundated with claims, leading to record backlogs, frustrated healthcare providers, and added complexity.

The Hyperscience Platform streamlines how state and local agencies complete Medicaid claims processing, automating the ingestion and extraction of HCFA forms and supplemental documentation and transforming it into accurate, actionable data that can speed up the time-to-reimbursement.

The Medicaid eligibility extension stemming from the COVID-19 Public Health Emergency (PHE) is due to end when the Secretary of the Department of Health and Human Services decides. Upon doing so, redetermination will have to be performed for all (over 80 million) current members.

This substantial task will be delegated to the state and county level, with some states even requiring this process to be completed within 90 days of the PHE ending.

With Hyperscience, these agencies can automatically process redetermination documents with the speed and efficiency required to meet the fast incoming deadlines.

Eligibility & Enrollment

With eligibility requirements changing daily and enrollment volumes showing no signs of slowing down, public sector organizations are eager to simplify their complex processes to streamline their operations.

The documents required to determine Medicare and Medicaid eligibility vary state to state and person to person. Only the Hyperscience Platform has the flexibility required to allow agencies to inject diverse, complex document formats into the process and reliably extract, verify, confirm, or enrich that data to be utilized downstream in your eligibility and enrollment workflow.

Automatically process critical documents including:

  • State Driver’s licenses or ID cards
  • Pay Stubs
  • Tax Documents
  • Medical Bills
  • Benefits Statements
  • Passports
  • Immigration Status Documents
  • Utility & Service Bills
  • Veteran Documentation
  • Letters of Proof of Residence / Employment

The automated functionality provided by the Hyperscience Platform enables agencies to upgrade the manner of which they process Medicare enrollment and Medicaid enrollment. Expedite processing times by leveraging automated classification, collation, deduplication, extraction, and redaction with one intelligent platform—regardless of document types or content types.

Get a Demo

Our experts will walk you through:

  • How to classify and extract data across complex, difficult-to-read documents, including handwritten forms, PDFs, images, emails and more.
  • How the Hyperscience Platform intelligently plugs into your document processes with out-of-the-box and customizable tasks, workflows, and connectors.
  • Plus live expert Q&A to answer any questions you have!
Please select an available date below to begin
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