Qantev AI Claims Platform
by Qantev
The leading AI claims platform for health insurance
At Qantev, we empower health insurers to achieve operational excellence through intelligent automation. Our AI-powered platform transforms how insurers handle claims processing and fraud detection, turning their biggest pain points into competitive advantages.
Our Claims Registration module streamlines claims processing with automated workflows that leverage AI to capture, validate, and enrich data from any document type including (but not limited to)claim forms, medical forms, invoices, prescriptions, medical certificates, ID documents, and membership documents. Our advanced AI processes multiple input data formats including handwritten and printed text, checkboxes, tables, QR codes, and barcodes to ensure that every piece of information is digitized accurately. The platform performs document verification using rules-based lists and data-driven validation, while seamlessly verifying member identities and provider credentials against your database. Our medical code inference engine automatically extracts and assigns ICD-10 and CPT codes from free-text diagnoses and procedure descriptions, dramatically reducing manual coding efforts.
Our Fraud, Waste & Abuse detection system employs automated algorithms to identify patterns of unnecessary, mislabeled, and fraudulent services. The solution integrates seamlessly at both prepayment and post payment stages to catch fraudulent patterns before they impact your loss ratios. Our out-of-the box alerts catalogue includes billing conformity checks for duplicates, pricing anomalies, and procedure-patient mismatches, alongside prepayment and post payment analysis that detect document forgery, upcoding, and abnormal prescription patterns. The platform's case management capabilities enable efficient investigation workflows with assignment tracking, actionable checklists, document management, and integrated reporting, which are all accessible through intuitive dashboards that prioritize alerts, monitor SLAs, and track team performance.
Together, these modules form an integrated ecosystem that empowers insurers to process claims faster, detect fraud earlier, and make data-driven decisions that improve loss ratios and member satisfaction while reducing operational costs.
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