Hospital-Side Medical Insurance AI Risk Control All-in-One Machine

Medical Insurance Risk Control

Project Background

Deployed Chinasoft International's hospital-side medical insurance AI risk control all-in-one machine, docking with HIS, EMR, imaging, and material systems to real-time audit inpatient cases. Enabled "dual-engine audit," dynamically matching 5000+ medical insurance policies, and realizing multi-modal data fusion analysis based on NLP and OCR.

Solution

Risk control capability upgraded, violation detection rate increased by more than 40%, real-time interception of violations during the process, reducing medical insurance denial disputes by 60%.
Single case audit time shortened from minutes to milliseconds, supporting daily audit of 100,000+ cases, and human cost reduced by more than 50%.
AI provides traceable audit trails, ensuring transparency and traceability for inspections and audits, reducing legal dispute risks.

Customer Testimonial

"After Chinasoft International's hospital-side medical insurance AI risk control all-in-one machine went online, our medical insurance compliance management shifted from passive response to inspections to active real-time prevention and control. The system automatically scans all inpatient data every day, discovering violations in advance during or even before the event, significantly reducing the amount of medical insurance denied payments, and doctors have gradually developed compliant diagnosis and treatment habits."