In auto and injury insurance, claim packages often include a large volume of documents from first-party and third-party medical bills, treatment records, correspondence, to attorney letters; all packed into a single submission. Managing, verifying, and extracting data from these packages is time-consuming, error-prone, and requires clinical context. EvoluteIQ addresses this with intelligent automation that handles indexing, splitting, labeling, and data capture dramatically reducing manual effort and improving accuracy.
Automated Document Intake & Classification
Documents are ingested from connected source systems and processed through intelligent page recognition. The platform identifies up to 29 distinct page types such as billing forms, treatment logs, and correspondence. It then cross-references patient names and claim annotations to determine whether the submission involves one or multiple patients.
AIS ISL & Data Capture Integration Approach Process Flow (To-Be Model)
Splitting & Labeling
- Multiple-patient packages are automatically split by patient, then further segmented by provider. Modifiers like “Additional Patient” are used for unannotated names.
- Single-patient packages are split into “Bills,” “Bills with Medical Records,” or “Correspondence” as needed, with clear linkage between parent and child documents maintained for full traceability.
Indexing & Data Capture
Only finalized bill splits proceed to data capture. Extracted fields include provider tax IDs, CPT/ICD codes, service dates, specialties, and bill amounts. The system applies advanced business rules to assign default values, classify specialties (e.g., general practice), detect durable medical equipment billing, and ensure consistent sequencing across forms.
A major benefit: HIPAA compliance is ensured, with zero indexing errors achieved through automation.
Human-in-the-Loop Verification
EvoluteIQ uses round-robin task assignment to distribute verification jobs. Processors review splits and extract data, correct issues, and submit validated records. All updates sync in real-time to downstream claim systems via API; removing manual data re-entry and accelerating process.
Business Benefits: End-to-End Transformation
EvoluteIQ streamlines the most challenging aspects of auto and injury claim processing. This improves quality, compliance, also lets adjusters and clinical reviewers focus on complex decisions; clearing the path for faster, more accurate resolution of claims.
