COI.
search Request for Consideration arrow_forward menu
close Submit Innovation
close
Claims / Insurance verified Verified Outcome TRL 9

Automated Medical Records Redaction

domain Client: A top US commercial insurer handshake Provider: Hyperscience schedule Deploy: Q2 2021 (Scale)
89 Impact
Enterprise Ready
Evidence Score: 4/10
Strength: Medium

Executive Summary

ANALYST: COI RESEARCH

To speed up claims processing while minimizing liability, the insurer automated the ingestion of messy medical records. The system uses AI to extract relevant injury data for the adjuster while automatically redacting sensitive, non-relevant history (e.g., mental health records, previous unrelated surgeries) based on privacy policies.

rate_review Analyst Verdict

"Operational efficiency meets privacy. Adjusters shouldn't see a claimant's entire life history, just the broken leg relevant to the car accident. Automation enforces this 'data minimization' principle better than human reviewers, who often over-share."

lock
Full Audit Report Available Includes Risk Register, Technical Specs & Compliance Data.

warning The Challenge

Claims adjusters received 500-page PDFs of medical records. Reviewing them was slow. Furthermore, records often contained irrelevant sensitive info (e.g., HIV status) that, if seen, could lead to bias accusations or regulatory breach.

psychology The Solution

The AI platform classifies document pages. It extracts the structured data needed for the claim. It applies a 'Redaction Policy' to mask defined sensitive terms or pages before presenting the packet to the human adjuster.

settings_suggest Technical & Deployment Specs

Integrations
Guidewire
Deployment Model
On-Prem / Private Cloud
Data Classification
PHI / Claims
Estimated TCO / ROI
Medium
POC Summary (2020-01-01 to 2021-01-01)

"N/A"

shield Risk Register & Mitigation

Risk Factor Severity Mitigation Strategy
Missed Info High Confidence thresholds trigger manual review.
Model Drift Medium Continuous training on new hospital form layouts.

trending_up Impact Trajectory

Audited value realization curve

Processing of millions of pages annually Verified Outcome
Primary KPI70% reduction in manual review time
Audit CycleAutomated redaction of sensitive non-claim data

policy Compliance & Gov

  • Standards: HIPAA
  • Maturity (TRL): 9
  • Evidence Score: 4/10
  • Data Class: PHI / Claims

folder_shared Verified Assets

description
Verified Case Study
PDF • Version 1
lock
verified_user
Technical Audit
PDF • Audited
lock

Related Intelligence

article
Digital Title & Closing Platform
View Outcome →
article
Digital Cytology for Cancer Screening
View Outcome →
article
National Data Exchange Layer (X-Road)
View Outcome →
Security Architecture

The "Blind Verification" Protocol

How we verified these outcomes for A top US commercial insurer without exposing sensitive IP or identities.

Private
lock_person

1. Raw Evidence

Audit ID: #PRIV-895
Evidence: Direct SQL Logs
Public
public

2. Verified Asset

Outcome: Verified
Ref ID: #COI-895

Strategic Action Center

Identify your current stage and take the next step.

rocket_launch
Replicate This Success
Want similar results? Request a deployment consultation.
psychology_alt
Submit Challenge
Have a different problem? Submit your problem statement.
publish
Publish Case Study
Submit your own verified evidence.
thumb_up
Verify Impact
Audit your existing solution.