How Generative AI-powered Medical Record Intelligence transformed utilization management for a top US healthcare organization

Most businesses underestimate what manual document handling actually costs. We break down the real numbers — time, errors, headcount, and missed revenue.
Solutions Used
Industry
Healthcare

Business Challenge

A leading health plan processing 45,000+ monthly authorization requests faced critical operational bottlenecks. Medical review staff spent 35-50 minutes per case manually reviewing physician orders, diagnostic reports, clinical notes, and treatment histories.

Finding relevant information required lengthy reports across multiple documents. The organization needed intelligent automation to accelerate workflows while maintaining decision quality and regulatory compliance.

Solution Offered

Novacis Digital delivered a Document Intelligence Platform with Conversational Search combining automated document processing with natural language search. The platform automatically categorizes documents (60+ types), extracts key information, and verifies coverage criteria.

Reviewers ask questions in plain English like "Has the patient tried two conventional medications?" and receive instant answers with source references. Pre-configured workflows handle common scenarios with continuous learning for improved accuracy. The secure architecture keeps patient information within the health plan's environment with no data stored beyond active sessions.

Document Intelligence Capabilities

  • Automatic document categorization (60+ types)
  • Key information identification and retrieval
  • Coverage criteria verification
  • Intelligent case summaries
  • Digital conversion of paper/fax documents

Conversational Search Features

  • Shows exactly where answers came from
  • Combines information from multiple records
  • No patient data stored or retained
  • Instant response to queries
  • Ask questions in plain English

Results Delivered

The solution was deployed using a secure architecture that keeps all patient information within the health plan's environment while leveraging cloud-based AI capabilities, ensuring privacy compliance with no data stored beyond active review sessions.

Business Outcomes:

50%

reduction in review time

50%

reduction in review time

50%

reduction in review time

50%

reduction in review time

50%

reduction in review time

50%

reduction in review time

Additional Value:

  • 37% improvement in staff satisfaction
  • 24-point gain in member satisfaction
  • 28% reduction in staff turnover
  • Improved regulatory audit readiness
  • More consistent decision-making

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