Bill Smith, Senior Vice President of Product Management
Benefit verification (BV) is an important process that helps patients access the therapies they need. An extensive BV has five components and often involves various phone calls and tedious exchanging of paperwork between provider offices, payers, and third-party hub services support providers. This can become a significant barrier between the patient and their ability to start taking medicine. In response, Lash Group launched eBV, an electronic benefit verification system powered by SmartPointSM, a proprietary artificial intelligence (AI) technology. This innovative tech increases speed to therapy by reducing the time to benefit verification to hours instead of days.
Logic-based eBV approaches rely on humans to manually—and accurately—program product coverage on a payer-by-payer basis, with reliance on the manufacturer or hub to provide coverage rules.
To bypass manual input from humans, eBV’s AI-powered technologies, which have machine learning capabilities, use massive amounts of historic data to “train” models, which, in turn, produce a coverage answer. If the system isn’t confident in the coverage information, it triggers intervention from a benefit counselor to phone the payer to reconcile the coverage information. The algorithms analyze new entries in real-time and identify the emergence of new rules and trends, all while eliminating the need for manual reprogramming. In short, eBV improves itself.
eBV’s innovations promise to drive improvements in the speed and precision of predicted benefit-related outputs. While technology undoubtedly improves a variety of healthcare processes, including BV, it is equally important to acknowledge the indispensable value of the human element. By blending high-tech processes with the smart touch of human intervention, eBV can transform the healthcare landscape and create healthier futures for all.