Humana Eligibility Verification For Providers – Humana, a leading health insurance provider, has reduced costly pre-service calls and improved the provider experience with conversational AI.
One of the largest insurance providers in the United States, Humana provides Medicare Supplements, health insurance, dental insurance, vision insurance and pharmacy coverage to more than 13 million customers nationwide.
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Humana Eligibility Verification For Providers
To differentiate itself in a complex and important space, health care and insurance companies must continue to innovate to improve customer service and retention. Consumers expect to receive quick and accurate answers to their questions wherever and whenever they want. Increasingly, service providers are forced to rethink their service offerings to meet consumer expectations.
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Humana’s interactive voice response (IVR) system transferred too many calls to human agents, at a great cost to the company and customer satisfaction scores. Health care provider administrative staff contact Humana by phone with questions about Humana member health plan benefits and eligibility. Humana receives more than one million calls from carriers each month, and most callers opt out of the IVR system to be sent to an external call center, for which Humana pays for the call. More than 60% of these calls are related to routine, specific and pre-service questions with clear answers.
To meet rising consumer expectations, Humana needed to completely rethink the way it approached customer inquiries. Humana’s Provider Service Innovation (PSI) team is tasked with finding solutions that can better address these costly pre-service calls and improve the provider experience.
This is not the kind of technology you set up and use. It requires monitoring, training and guidance to apply true understanding. that can be collected.
Conversational assistants were nowhere near or as advanced as they are now when Humana began this journey in 2016, but the company recognized the deep promise of artificial intelligence in customer service. Humana chose to partner with Watson®, the industry leader in enterprise AI, and began working with it
Agent Self Service Center
Data and AI Expert Lab & Learning (DAELL). After a three-month proof-of-concept (POC), Humana began developing what would become the provider’s interactive voice agent with Watson. The solution combines multiple Watson applications into a single conversational assistant, which runs in the Cloud®, while the Watsonx™ Assistant for Voice runs on Humana’s premises.
Humana Voice Agents with Watson provides a faster, friendlier and more consistent way for healthcare providers’ administrative staff to access pre-service information, medical eligibility, verification, authorization and referrals without having to speak to a live agent. The solution is based on AI to understand the meaning of the operator’s call, verify that they are authorized to access the member’s system and data, and then determine the best way to provide the requested information.
The voice assistant uses significant voice customization with seven language modes and two voice modes, each targeting specific types of users collected by Humana. Through audio tuning training, the solution achieved an average accuracy of 90%-95% sentence error rate on meaningful input. The practice manages multiple subdivisions within the main group of Rights, Benefits, Claims, Authorizations and Transfers, allowing Humana to quickly answer unanswered questions. In previous IVR systems, requests for “benefits” could send a fax of seven pages. Currently, Watson’s solution can respond to certain benefits “one time”, such as “paying for a chiropractic visit is $100.”
We do it blindly: we do not tell the seller that they will be in a new environment, because we want to understand their reaction, so we can adapt and continue to develop and observe Watson.
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The solution began handling live calls from healthcare providers in April 2019, with several updates throughout the year to expand functionality and user base. It can handle inquiries at about a third of the cost of existing systems and has a higher overall response rate, nearly double that of previous automated IVR systems.
Throughout development, the Watson Expert Services Lab team has driven improvements to Watson services with personalized training and models capable of better understanding healthcare terms in low-bandwidth call center environments. This has led to the filing of several patent documents, and the team has published tools, guides and methods for building, testing and tuning large-scale Watson Voice Assistant solutions. The Humana voice assistant solution model has recently been officially updated to offer the watsonx voice assistant solution.
“Humana voice agents have improved self-service capabilities for Humana’s healthcare providers, allowing them to quickly and efficiently get information about patient insurance across multiple data points. To connect with call center representatives. “We have a level of insight into these interactions that we never had before,” said Sara Hines, director of provider experience and connectivity at Humana.
The solution receives more than 7,000 voice calls from 120 service providers every working day and User feedback is overwhelmingly positive. “Humana’s initiative with Watson has been in development for three years and continues to grow even after implementation,” said Hines. “This is just the beginning of how Humana is improving our supplier communications, and I’m excited to continue exploring the endless possibilities of artificial intelligence.”
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For more information about the solutions presented in this article, please contact your representative or business partner.
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Provider Self Service Portal From Humana
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