2019 Winner Profile

Aetna, a CVS Health Company

Project Description:
Complex healthcare provider contracts have traditionally required significant human involvement for claims processing: Reading free-form comments, calculating pricing and updating claims can take weeks or months. Aetna's auto-adjudication app leverages AI with natural language processing and unstructured text parsing to identify payment attributes and construct additional system-readable data to more rapidly resolve complex contracts with healthcare providers. The project's ROI was realized within four months, with savings in processing and rework costs. This allowed over 50 staff members to focus on other contracts and claims that require a higher level of research and provider coordination.
Business Goal:
Operational Impact
CIO:
Meg McCarthy
CEO:
Larry Merlo
Headquarters:
Hartford, CT
Industry:
Healthcare
Website:
https://www.aetna.com/
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