How AI helps HMO claims teams catch billing errors
AI checks every line of a hospital bill so duplicate charges are not missed on busy days. The claims reviewer still decides what gets paid.
When a hospital bill comes in, the claims team checks every line against the member's plan and the approved letter of authorization (LOA). On a busy day, mistakes slip through, like the same lab test charged twice.
Sample data. Numbers are AgentConnect estimates.
In this video, AgentConnect by LYRIQ checks every line of a ₱32,470 hospital bill. Room and board and the doctor's fee are payable. A duplicate ₱2,700 lab charge and an unapproved room upgrade are flagged. A claims reviewer makes the final call, and the settlement, emails and ledger are done for them.
The result: ₱26,270 payable, with the duplicate caught before payment. 46 minutes of review down to about 0.7.
See more at lyriq.ai. You can also read about LYRIQ on BPOAI.ai.
Related reading: Optimize, Don’t Redesign · We Are Not a BPO. That’s Why We Need One · Inside Sourcefit’s AI Work