Instabase for Health
Health insurance payors handle large volumes of unstructured data from healthcare providers, vendors, policyholders, and others as part of the revenue management cycle. These unstructured documents require manual processing and data extraction. Instabase helps payors by automating these unstructured processes.
Use Cases
How Healthcare Payor Organizations are using Instabase
Patient Registration

Payors need to understand specific details about a prospective patient in order to onboard them to their service. This is typically completed through digital channels, and takes a combination of structured data intake (e.g. online form) and supplementary documents to evidence certain attributes (e.g. proof of address).

Instabase enables payors to automate, validate and extract relevant information from complex documents, and help them serve customers faster, thereby improving time-to-value.

Provider Enrollment

Payors enroll large number of providers across their networks, and frequently manage their status to ensure smooth day-to-day operations. This involves gaining an understanding and evidencing key data points that are included in documents.

Instabase helps payors automate the whole process, reduce friction, and deliver faster outcomes with lower costs.

Patient Onboarding
Streamline end-to-end patient onboarding with automated document understanding. Eliminate manual review, reduce onboarding times, and comply with regulations at scale.
  • Patient Registration
  • Provider Enrollment
Procedure Code Mapping

When providers deliver service to patients, payors reconcile and calibrate the codified details of the procedure. This includes details about the service type, medical condition, quantities, and provider – which are codified in CPT and ICD10 codes.

Instabase’s intelligent document processing unlocks this data with the highest accuracy to ensure downstream billing processes are correct.

Provider Claim Editing

Incoming claims need to be ingested, classified, reviewed, and then reformatted into a data schema that each individual payor can consume. This applies to both structured claims and unstructured claims that involve documentation. 

Instabase uniquely helps health insurance payors during the steps preceding adjudicating the claim by automating the process, increasing accuracy, and reducing the processing time.

Service Delivery
Transform the claimant experience and extract more value by unlocking data trapped in messy and unstructured claim documents. Decrease handling times, identify claims that qualify for reimbursement correctly and reduce the cost base.
  • Procedure Code Mapping
  • Provider Claim Editing
Appeals & Denials

As part of the adjudication process, claims are either approved, denied, or require more information. This result in a range of manual tasks that need to occur in order to manage appeals from patients, investigations, and administration of denials — creating a cost center within the revenue management cycle.

Instabase uniquely helps health insurance payors during the adjudication process by increasing accuracy and reducing the processing time.

Utilization Management

Utilization Management prevents fraud by assessing the cumulative usage of healthcare plans by patients. This analysis typically happens as part of Claims Adjudication, either to proactively or retrospectively prevent misuse or overpayment.

Instabase uniquely helps health insurance payors with utilization management by increasing accuracy and reducing the processing time.

Risk Management

The Risk Management (or Adjustment) process primarily takes place in Medicare, where the payor is the administrator of plans that are paid by the U.S. Government through CMS. Both as an ongoing activity as part of Claims Adjudication, or a one-off audit exercise, this involves evaluating medical records to identify conditions that can be coded to map with the CMS database (ICD10) and receive payouts accordingly.

Instabase uniquely helps payors with the automation of the medical coding process, creating more accuracy in the process and saving costs.

Claims Adjudication
Incoming claims need to be adjudicated through a review of accompanying medical documents. Appeals & denials to claim decisions are common. Usage is also carefully reviewed to monitor costs.
  • Appeals & Denials
  • Utilization Management
  • Risk Management
Invoice Processing

The latter phases of revenue cycle management focus on preparing for payment. This involves evaluating and reconciling incoming invoices and remittance-related documents to understand which balances are due, to whom, and by when.

Instabase uniquely helps health payors by automatically extracting the relevant information from complex invoices and matching this information against internal or external databases for validation and payment decisions.

Payments & Operations
Health payor operations are complex with many stakeholders. Cross-billing and reconciliation is a constant activity and made more complex by the high variability of incoming invoices.
  • Invoice Processing