Acrometis: Managing the Big 'Insurance Claims' Data

Joe Antonio, CTO, AcrometisJoe Antonio, CTO
Acrometis’ President and CEO, Jerry Poole conceived CLAIMExpert—a comprehensive expert claims processing platform— to usher a blend of efficiency, consistency, and predictability in processing claims.

“The CLAIMExpert platform is used as a foundation to consistently apply best practices, processes, and introduce standardization to the interpretation, conditioning, and treatment of claims data,” begins Joe Antonio, Acrometis’ Chief Technology Officer.

Regardless of the industry, organizations currently reside in the big data moment, where they can get hold of overwhelming volumes of data at their fingertips; though it is difficult to prioritize and manage. This predicament spurred the idea of Acrometis’ CLAIMExpert, a tool that focuses on identifying, capturing, and managing high quality and relevant claims information for accurately approving bills, assessment of changing claim conditions, and management of performance based data and results for reporting.

Acrometis’ platform encompasses soup-to-nuts elements of workers’ compensation claims processing by leveraging automation, artificial intelligence, and an improved user interface to provide access to accurate and timely information within the claims workflow and decision guidance based on predictive analytics. CLAIMExpert’s automated ingestion, digitization, auto-adjudication, and highly evolved Workers’ Compensation adjuster’s toolset curbs the requirement of manual human intervention.

“These features contribute to a concise and logical presentation of relevant claims information and facts to assist and guide the adjusters,” states Antonio. “CLAIMExpert enables the Workers’ Compensation and Auto/PIP insurance industries to manage all facets of claim decisions including auto-adjudication of 75 percent of all their medical bills. This frees up a sizable portion of a claims adjuster’s day and creates huge cost savings.”

The platform also manages a customer’s medical spend by identifying routine invalid data, reviewing medical bills and treatment against enforceable medical guidelines, providing intelligence based guidance to adjusters, detecting patterns of fraud, and more.

The CLAIMExpert platform is used as a foundation to consistently apply Best Practices, processes, and to introduce standardization to the interpretation, conditioning, and treatment of claims data

Fostering innovative ideas in a collaborative setting, the Acrometis team assists clients to sew disparate claim-related systems into a single entity and leverage real-time reporting with executive and operational dashboards that both report on and project critical performance criteria.

The Acrometis team is strengthened by their decades of industry experience, the seamless integration between their business and technology groups, and their commitment to achieving exceptional results for their clients.

“The platform presents critical, relevant claims information in a format that is easy to understand and actionable by adjusters aiding them in making important business decisions,” explains Antonio.

From processing electronic bills (eBills), Keying from Image (KFI) of the original medical documents,and medical bill review to integration with partners for PPO network savings, and compliance with state/NCCI reporting requirements, clients have engaged with Acrometis for improved business results.

“In actual use , CLAIMExpert has saved clients up to 23 additional percent on their loss and LAE reduction at Go Live, while vastly reducing the time spent manually processing all bills and non-medical documents,” extols Antonio.

“Our flexible solution treats and manages claims data and documents to provide clients automation and delivers relevant information to the adjuster, medical case manager, bill reviewer, or other stakeholders in the claim to facilitate accurate decision-making,” says Antonio.

For the future, Antonio firmly believes that timely intelligence and predictive analytics can improve claims processing and outcomes. This is where the company will continue to be a game-changer by developing enhanced solutions.

“We listen to our client’s problems and incorporate their feedback into our product and strategic planning,” wraps up Antonio.