Humanizing payor-provider interactions one task at a time

Healthcare providers have a clear and urgent requirement: they want payers to process authorizations, claims, and payments quickly and accurately. They have been long burdened by cumbersome, outdated data submission and bureaucratic processes.

But healthcare payer IT leaders are saddled with big, expensive, and lengthy change processes – both on provider portals and on the backend data architecture that support them. This makes it difficult to both modernize this critical interaction and satisfy regulatory demands.

Artificial intelligence (AI) capabilities, when properly deployed, can dramatically simplify both the front- and back-end work that this portal modernization needs. Healthcare IT leaders can kickstart the modernization process with two key actions.

1 – Create a value-risk matrix to prioritize portal tasks for AI transformation

Every provider application – whether a front end portal or a data submission process – comprises a battery of tasks or use cases that providers and health insurance members make use of. During the initial exploration phase, a value-risk matrix enables IT leaders to identify which tasks or use cases are optimal targets for AI, such as an AI-powered eligibility check or a GenAI claims agent. The matrix also serves as a basis to consolidate backing for the project among executive management and line of business (LOB) leaders.

An experienced systems integrator such as TCS can work with IT leaders to quickly identify likely use case candidates. Once they’ve been identified, TCS can then adapt its AI platform – TCS AI Catapult Forward – to the targeted functions. TCS and Microsoft collaborate to build and deploy new capabilities designed for AI in the Microsoft Cloud, such as Azure AI-powered cognitive searches, modern cloud-native services, business copilots for a specific provider interaction, and much more. Finally, TCS and Microsoft integrate these capabilities into the existing payer application and scale as needed.

These focused AI projects will pave the way for future development: text-and-character oriented web portals are already starting to give way to AI-powered conversational interactions using natural language. Providers or members will be able to ask direct, simple questions of the GenAI copilot and receive direct, simple answers. And vice versa: AI copilots will be able to proactively reach out to providers and members with updates, alerts, reminders, and more.

2 – Establish a trustworthy, unified data foundation on the back end

Successful AI deployments require ready access to very large volumes of quality data. Existing back-end data processing – so vital in healthcare payments – must also be modernized. A trustworthy data foundation layer is critical to long-term, successful AI implementations. This foundation is a top priority for healthcare IT leaders.

The good news is that AI tools, including software development, can simplify and speed up creating this modern data foundation.

TCS and Microsoft have a proven track record of working together to create this foundation. TCS has developed generative AI (GenAI) agents and copilots to enable payer IT teams to identify key legacy apps and their attendant data. AI agents can then begin to write, read, test, and document the code for a new generation of data processing applications. Data can be moved over time into a cloud-based data lake while other AI agents have an expanding role in managing the data. All these capabilities are available as a suite of services through Microsoft Cloud.

The bottom line

AI tools enable healthcare payer IT leaders to modernize both their provider applications and the backend data that feeds into these portals. AI can be used in provider- and member-facing use cases to simplify and “humanize” the portal experience. And AI-powered application development and data management tools – enabled via cloud and software-as-a-service offerings – can smooth the way to a trustworthy, unified data foundation.

To learn more, visit Patient-centered Care: Health and Wellness Redefined.