Virtusa’s A&G is an AI-powered solution built with six interconnected modules to simplify case management and automate task handling. With machine learning (ML) at its core, the solution provides intuitive and guided workflows to help users navigate the complex case life cycle.
Virtusa’s A&G solution helps accelerate case resolution with AI-assisted clinical review for real-time recommendations to doctors and nurses to enable accurate decision-making for pre and post-service appeals.
Virtusa’s A&G has six interconnected modules that enable an appeal or grievance case to get processed end-to-end. A module is selected based on the business need and ROI. The modules include:
Virtusa’s A&G helps businesses with caseload management and stay within regulatory timelines when filing and processing an appeals or grievance case. Backed by AI-based algorithms, the solution eases caseload, automates task handling, and streamlines complex business rules with the following workflow:
With Virtusa’s A&G healthcare payers:
Virtusa’s A&G helps users navigate the complex case life cycle, achieve high customer satisfaction, and ensure better adherence to regulatory guidelines with the following advanced features:
Virtusa’s A&G is HIPAA compliant with security standards and has the highest security rating with HITRUST CSF certification. The solution’s IT infrastructure has advanced security controls to protect sensitive personal data and is compliant with all mandated regulations.
Virtusa’s A&G processing solution uses AI-based real-time recommendations for simplified case management and automated workflows. A clinical review by a registered nurse and medical director is administered where cases are smartly routed based on the skills of the registered nurse. Decision-making capabilities are simplified by AI-assisted algorithms for medical directors when looking at pre-and post-service appeals. The registered nurse has access to a portal with a dashboard for a holistic view of the pending case.
Virtusa’s A&G dashboard gives the registered nurse a 360-degree view of the claim or authorization available for verification. A prompt decision at a line-item level is initiated, allowing an AI-powered model to compare the current claim or authorization. It gives access to all previous ones in the database and recommends approval at the code level of the claim line procedure. The registered nurse reviews the case parameters and medical records aligned to the appeal. The system then allows the registered nurse to make a swift decision backed by insights derived from historical data.