Automation
Interoperability
FHIR
EDI
Data Analytics
AI in Healthcare
Compliance
TiC
Prior-Authorization Access
Patient Access
Product Engineering

The healthcare ecosystem, driven by advancing technology, is shifting towards patient-centric care. To support this transition, payers are increasingly seeking ways to intelligently automate workflows, optimizing operations while reducing time and resource waste.

AI healthcare services offer the potential to enhance population health management (PHM) efforts in line with compliance. At Nalashaa, with our deep expertise in healthcare IT, we know what it takes to help you achieve these goals.

Are You Facing These Challenges Too?

As a payer organization in the current business ecosystem, you are bound to have come across one or more of these challenges across the following areas.

Data Management and Analysis

Population Stratification | FWA | Network leakage

Alignment with Compliance Measures

HEDIS | STAR ratings

Education

Members | Providers | Family | Social Workers

Preventive and Proactive Healthcare

Care plan adherence | Wellness |Regimen Mgmt.

Linear Revenue/Cost association

Claims management | Customer Service | Contracting

Eliminate These Challenges
Challenges for Healthcare Providers

Our AI Healthcare Services to the Rescue

While possibilities and specificity may vary with your context, below is a starter’s kit.

Fraud Detection in
Claim Requests

AI models that reject/flag claims for further investigation

Intelligent Claim
Management

Intelligent correction of errors to improve auto-adjudication

Predictive System
Maintenance

Use historical data to anticipate and address potential issues

Reduce Network
leakage

Identify referral trends to affect provider/member behavior

Identify opportunities
for CDI

NLP application to Clinical Documentation

Chronic Illness Risk Assessment

AI models to predict chronic illness from historical patient data

Avoid Re-admissions

Monitor patients to anticipate re-admissions and issue necessary interventions

Smart Symptom Checker

ML algorithms asses HPI and patient inputs for accurate care recommendation

Proactive and Preventive Care

Wellness visits, care programs to take timely and efficient action

Personalized Digital Marketing

Intelligent insights on digital interaction patterns to customize messaging

24x7 Support Bots

Emulate real-time conversations with members using AI and NLP

Intelligent Appointment Scheduling (IAS)

Reduce No-shows based on member interaction, profiles and history

Smarter Reimbursement Contracts

AI enabled suggestions on reimbursement contract negotiations

Routine Provider Credentialing

An automated validation process built on a provider credentialing checklist

AI assisted Provider Education

Contextual, well-timed education compliance with pathways, guidelines, regulations

Remote Interventions

AI-driven proactive RPM to anticipate adverse events without consistent visits

STAR Rating

Data-driven improvement strategies to match the moving standards

Clinical Rating

Simultaneous analysis of multiple data source for accurate rating

Quality measures

Feed algorithms with quality measure to match compliance expectations

Customer Satisfaction Measure

Analyze patient data to offer optimized actionable recommendations

Be the Captain of Your Success

Optimize your healthcare operations in line with the necessary KPIs with supervised and un-supervised ML algorithms.

Reduce Turn Around Time

Improve ROI

Better Member Response

Reduced Member Churn

Refined Provider Performance

Up-to date with Compliance

Seamless Transition of Care

Smooth Contract Negotiations

Challenges for Healthcare Providers
Connect With Our Experts

Partner With Us

At Nalashaa we have the best in Healthcare IT helping you navigate through the trenches of the vast and confusing healthcare ecosystem.

Assess business to set realistic goals

Identifying workflows that need AI solutions

Measure and track necessary KPIs

Experts in healthcare product development

Experience Optimized Success with AI Healthcare Solutions

Experience Optimized

Success with AI Solutions

Let us Help Build Customized AI Solutions
to Unleash Your Data and Advance
Patient-centric Healthcare

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Frequently Asked Questions

How is AI used in healthcare today?
AI is used in healthcare for both basic and advanced tasks. General AI handles repetitive functions like administrative workflows and data analysis, whereas specialized AI models manage complex tasks in specific areas. These narrow applications include patient management, disease diagnosis, and providing treatment suggestions for efficient and accurate care delivery.
How will AI impact healthcare in the future?
AI is expected to become deeply integrated across the healthcare industry, moving beyond experimental projects to full-scale enterprise implementations. This will influence every aspect of healthcare delivery, from diagnostics to patient management and treatment optimization.
How is AI used in revenue cycle management?
AI in revenue cycle management is used to improve patient and payer payments, with 83% of hospitals focusing on this goal. 80% of hospitals use AI to enhance cash flow. The most common AI applications in RCM include eligibility and benefits verification (72%) and patient payment estimation (64%).
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