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Status Submitted
Categories Health Care
Created by Guest
Created on Oct 29, 2025

IBM-AWS Innovathon 2025 - Late payment of healthcare claims is a persistent challenge, leading to financial penalties for payors—especially in U.S. states with strict mandates and high interest rates for delayed payments.

Proposed AI-Based Solution: Real-Time Claims Inventory Management for late Payment Reduction.

Objective:

Minimize late payment interest by proactively identifying and prioritizing claims at risk of breaching timely payment thresholds.

Key Features

1. Real-Time Inventory Prioritization

  • Sort claims based on date of receipt, pushing older claims to the top of the queue.
  • Highlight claims from high-penalty states for prioritized processing.

2. Complexity-Based Risk Scoring

  • Use AI to assess claim complexity and predict likelihood of delay (rankers).
  • Flag high-risk claims for early intervention and payout. 

3. Daily Governance Dashboard

  • Visual insights into claims nearing ageing thresholds to drive traction.
  • Alerts for claims approaching late payment interest basis identified triggers.
  • Summary of high-risk claims by state, age, and complexity which are routed to other departments and awaiting resolution; to prioritize such claims by internal department coordination. 
Idea priority High