Payers, Artificial Intelligence, Health Tech

Blue Shield of California, Google Cloud to develop real-time claims processing platform

The companies will build their claims processing platform on Google Cloud’s infrastructure, leveraging artificial intelligence and machine learning capabilities. The goal of the collaboration is to improve patient and provider experience and reduce spending on administrative processes.

Blue Shield of California and Google Cloud are joining forces to digitize and simplify the healthcare billing and payment process.

Together, the companies will create a real-time claims processing platform leveraging automation, artificial intelligence and machine learning technologies. The platform will be designed to streamline the back-end billing processes between Blue Shield of California and the providers it contracts with.

The solution will extract clinical data from the provider’s EMR and then codify that record into a digital claim for billing, said Lisa Davis, senior vice president and chief information officer at Blue Shield of California. The payer will adjudicate that claim and send back a claim settlement decision to the provider, which will be shared with the patient in near real time.

“Today, we all have an experience where we leave the doctor’s office, and we have no idea what we’re paying for,” Davis said in a phone interview. “We get this cryptic letter that says you have received ‘X’ services…and there is a cost associated with that. So, imagine being able to create…a retail-like experience where I go into the doctor’s office, I know exactly what I am paying for, I know exactly what those costs are.”

The companies have proved out a pilot case where the entire process, from extracting the clinical data to sending back a claim settlement decision, is done in less than 10 seconds, Davis added.

The platform will run on Google Cloud infrastructure. It will leverage Google capabilities to ingest, harmonize and normalize the clinical data collected from EMRs into the cloud data layer, said Aashima Gupta, director of Global Healthcare Solutions at Google Cloud.

Further, Google Cloud provides AI capabilities that the platform will use to glean insights from unstructured data like clinicians’ notes.

“The wealth of information is still in clinical notes,” Gupta said in a phone interview. “We need to extract the data out of the unstructured notes to a structured format and that’s where our technology like healthcare NLP can be super useful.”

One of the main goals of the collaboration is to reduce the amount spent on claims processing.

“Almost $256 billion is wasted due to the administrative complexity within the healthcare system [and] a large portion of that is related to health claims adjudication and settlement,” Davis said.

Another goal is to improve the patient and provider experience by alleviating the uncertainty of payment for patients and making the process more seamless for providers.

Blue Shield and Google are in the process of building their platform, which will be launched next year and tested by pilot partners, after which it will be available to all payers.

“The pandemic has brought to the forefront the need for digitization in healthcare in general,” Gupta said. “Our partnership leverages the strength of both companies… We are looking at this as a business transformation opportunity.”

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