Problem Statement

Health systems must manage a massive volume of unstructured payer correspondence arriving by mail, fax, and portal. Every refund request must be read, indexed, and routed before downstream teams can act, and doing this manually is slow and prone to backlog. Payers issue refund requests that must be reconciled against the account to confirm a true overpayment before any credit is resolved. Because of these processing delays, refund requests frequently go unworked, inflating Net Days in Credit Balance and creating compliance exposure when overpayments aren't returned within payer and regulatory timeframes.

Automation Solution

This automation extracts key details from paper insurance refund requests using document understanding, reconciles them against the account, and posts the information directly into the EMR to improve credit management and reduce manual entry.