Technology has transformed how we engage and transact with businesses, yet while many industries have modernized, healthcare remains slow to embrace change. In fact, many healthcare entities still rely on fax machines and phone calls between providers, patients, and payors to relay information and coordinate care. This manual coordination is one of the main culprits of delayed time to therapy.

In this post, we’ll discuss the state of digital payor data in healthcare today, explore the challenges associated with it, and dive into how Infinitus navigates the complexity of digital data to provide a high-quality eBV solution.

The state of digital payor data

There are two main challenges with fully digitizing benefit verification today:

  • No single source has all the data needed to complete a full benefit verification
  • Varying levels of coverage require redundancies and coordination between multiple data sources

While payors do have all the necessary data, and payor agents do have access to it, the data available to them exists as both structured and unstructured resources. For instance, payor agents may have access to a member’s benefits and eligibility information via portal, whereas information for prior authorization requirements and cost share for a drug or procedure live in PDFs that they need to sift through. 

The situation above is also reflected at the macro level where no single digital source from a payor or third-party entity has all the necessary data to complete a digital benefit verification. For example, a payor’s API provides benefits and eligibility info, however, they send their prior authorization data to a third-party clearing house or store it in their IVR. 

To compound this problem, reliability and coverage varies at the member level even within the same digital source. The payor API can return complete benefits and eligibility data for one member and only the policy effective date for another. This requires consumers of the data to integrate with multiple sources to build redundancies and increase coverage, introducing complexities on which digital source to prioritize for each data field.

Data centralization and connection across all their data sources is a critical step for all payors to offer all of this data digitally – but there’s still a long way to go before that can be made possible.

How Infinitus coordinates and prioritizes digital data sources

At Infinitus, we follow a simple philosophy for prioritizing digital data source for eBV, which is based on proximity to the payor’s source of truth. By following this approach, our digital AI agents can provide our customers with the most accurate data and complete picture as efficiently as possible so they can recommend the next best action for their patient. 

When a task is received, our digital AI agents leverage the Infinitus knowledge graph to coordinate data from various sources to put together a comprehensive eBV in the following priority: 

  • Direct sources: Data that is received from payors’ APIs and IVRs, EDI transactions from third-party clearinghouses, and CMS.
  • Customer and Infinitus payor intelligence: Institutional knowledge harvested from millions of phone calls performed by both the customer and Infinitus. Our knowledge graph continuously audits these data against payor agents to ensure they are always up to date.
  • After coordinating and aggregating the data, our digital AI agents rely on our embedded SOPs to assess each task for completeness. If any critical data elements are missing, our voice AI agents can obtain it via calls to payors, to ensure customers always receive a complete benefit verification. 

What sets Infinitus’s eBV solution apart

When customers receive the results of an eBV from our digital AI agents, they receive a complete and standardized data package that is aggregated through orchestrating various sources. With Infinitus, customers gain the following advantages:

  • Receive a white glove solution as opposed to integrating and maintaining various non-standardized digital sources
  • No data gaps – if necessary information cannot be obtained using existing data sources, our voice AI agents step in to make phone calls to payors to ensure customers always receive a comprehensive BV for every patient
  • Instantaneous turnaround time, which expedites decisionmaking and ultimately helps get patients on therapy faster

How to get quality BV data, faster

Our digital AI agents, which are powered by our knowledge graph, are bringing cohesion to decentralized healthcare data, and delivering high quality eBV for our customers. On top of that, our voice AI agents bring multi-modal capability in sourcing data from payor IVR’s beyond digital integrations.

Infinitus is committed to pushing the envelope on digital data availability to fuel our eBV solution through leveraging partnerships with payors as well as being at the forefront of new data sources as the technology landscape evolves.

If you’re a current customer interested in learning more about how to enable this for your organization, please contact your account team or email us at support@infinitus.ai. If you’re not yet a customer but would like to learn more about Infinitus, contact us here – we’re looking forward to sharing more about how we can help you deliver better outcomes for your patients.