An organization needed to clarify the healthcare claims it was processing for US veterans. The organization received and paid US TRICARE claims, based on contracts with healthcare providers nationwide. Many of the 2,500 contracts were signed decades ago, and there was no efficient way to check the amount due on a claim, or to check a contract’s compliance with today’s TRICARE standards. The contract formats also varied from one provider to another, so there was no single path to convert the unstructured information into standardized data..
The healthcare claim payer needed a way to check payment details and confirm compliance across thousands of unstructured contracts.