Journal of Advances in Developmental Research

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Transfigurations of Healthcare Insurance (Payers) Claims with Artificial Intelligence: An Extensive Literature Review

Author(s) Vineet KR Mishra, Siddharth Parakh, Vijay Vuradia
Country United States
Abstract : Health Insurance (HI) pays for medical as well as surgical expenditures incurred by the insured person, thereby rendering financial safety against the expensive costs related to Healthcare (HC) services. HC costs are effectively managed via the process of Healthcare Insurance Claims (HICs), where insured individuals submit claims to their insurance providers. This system of claims management streamlines the payment process and promotes better usage of HC resources by mitigating the financial barriers to accessing care. Although numerous benefits are attained, the HICs process could be time-consuming and error-prone. Delays for both patients and HC providers are often caused by errors. These issues can be solved more efficiently by integrating Artificial Intelligence (AI) into the claims process. Moreover, subsets of AI like Machine Learning (ML) and Deep Learning (DL) play a noteworthy role in enhancing the speed of HICs. These technologies can examine enormous data, detect patterns, and make predictions, further enhancing the claims process’s efficiency. By knowing the objective, this review explains the transfigurations of HICs through AI, concentrating on key aspects like Fraud, Waste, and Abuse (FWA) prevention, real-time claim adjudication, and predictive analytics. Additionally, the challenges of AI in HICs are also discussed in this review paper.
Keywords Healthcare insurance claim, Artificial Intelligence, Machine Learning, Deep Learning, claim adjudication, Predictive Analytics, and Convolutional Neural Network.
Published In Volume 16, Issue 1, January-June 2025
Published On 2025-06-27
Cite This Transfigurations of Healthcare Insurance (Payers) Claims with Artificial Intelligence: An Extensive Literature Review - Vineet KR Mishra, Siddharth Parakh, Vijay Vuradia - IJAIDR Volume 16, Issue 1, January-June 2025.
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