Organization

Multi-National Health Insurance Company

Scale

500+ Networked Healthcare Providers | 2 Million Insured Lives

Challenge

Insurance claims took 15-20 days to process due to manual verification. High denial rates (18%) due to missing documentation. Patient complaints about delayed approvals. Administrative overhead high (200+ staff processing claims).

Solution Implemented

• Doccure integration with insurance company’s claim system
• NAFIS (National Platform for Health & Insurance Exchange) connectivity
• AI-verified vital signs attached to claims automatically
• HL7-FHIR data exchange for medical records
• Real-time eligibility verification at appointment booking
• Automated pre-authorization workflows

Implementation Timeline

• Month 1-2: API development and integration
• Month 3: Pilot with 50 providers
• Month 4-6: Phased rollout to 500 providers
• Month 7: Full production deployment
• Ongoing: Monitoring and optimization

Results (After 12 Months)

• Claim processing time:15-20 days → 2-3 days (87% reduction)
• Claim denial rate:18% → 1.2% (93% reduction)
• 99.9% claim accuracy — AI-verified data reduces errors
• Patient satisfaction up 75% — Faster approvals, less paperwork
• Administrative overhead reduced 60%— Automated workflows eliminate manual tasks (120 staff redeployed to customer service)
• Fraud detection improved — AI flags suspicious patterns
• Provider satisfaction up 68%— Faster payment, less administrative burden

Process Before Doccure

1. Patient visits doctor → Doctor submits paper claim → Insurance receives claim via mail/fax (1-3 days)
2. Claims processor manually enters data into system (1-2 days)
3. Medical review team checks if treatment medically necessary (3-5 days)
4. Verification team checks patient eligibility, coverage (2-3 days)
5. Payment processed or denial issued (2-3 days)
6. Total: 15-20 days(if no issues; longer if documentation missing)

Process With Doccure

1. Patient books appointment → Eligibility checked automatically (instant)
2. Doctor conducts consultation → EMR documentation + AI vitals captured
3. Claim auto-generated and submitted electronically with all supporting docs (instant)
4. AI pre-checks claim for completeness, accuracy (instant)
5. Automated medical necessity verification (most cases approved instantly; complex cases flagged for human review)
6. Payment processed (1-2 days)
7. Total: 2-3 days(90%+ of claims)

Insurance Company Testimonial

“Doccure’s integration transformed our claims operation. AI-verified vitals give us confidence in medical necessity. FHIR data exchange eliminates missing documentation. We process 10x more claims with the same staff. Our NPS (Net Promoter Score) went from 22 to 68 in one year.” — Sarah Johnson, VP of Claims Operations

Provider Testimonial

“Before Doccure, I spent hours each week on insurance paperwork. Now, claims submit automatically, and I get paid in 3 days instead of 3 weeks. My cash flow improved dramatically.” — Dr. Ravi Kumar, Family Physician

Financial Impact

• Administrative cost savings:$15 million/year
• Fraud reduction::$8 million/year
• Customer retention improvement:12% (due to satisfaction increase)
• ROI:620% (first year)

REQUEST INSURANCE DEMO— See claims workflow automation