Healthcare

Palantir’s healthcare solutions integrate vast data sources to provide predictive analytics, enhancing patient care and optimizing resource management.

With real-time insights, healthcare providers can improve decision-making, streamline operations, and advance patient outcomes.
Explore the Use Cases

Use Case 1AIP Health Insurance Utilization Review Assistant

Optimize and expedite the creation of insurance utilization reviews through AIP-driven analysis and documentation assistance for hospital case managers.
Case Managers employ AIP to (1) assist in validating and reviewing patients’ charts to ascertain if documentation adequately supports the current level of care, and (2) generate draft claims documentation for insurance companies.

Upon patient admission, Case Managers employ AIP to produce a preliminary utilization review draft, which is then refined by the Case Managers and dispatched to the insurance company with wording optimized for claims acceptance.

Throughout the patient’s stay, Case Managers continue to leverage AIP for assistance with drafting ongoing utilization review notes. This process not only aids in avoiding insurance denials based on the patient’s level of care but also reduces the administrative load on Case Managers.
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Intelligent Chart Review

Case Managers use AIP to simplify the process of going through a patient's chart. Information potentially relevant to the appropriate level of care for a patient (e.g., abnormal lab results, patients' comorbidities, and risk factors based on clinical history) is highlighted for the Case Manager to review.

Extract Relevant Evidence

AIP enables Case Managers to apply their own evaluative criteria, including care guidelines for specific diagnoses, as well as payer-specific requirements, to craft utilization reviews that are more likely to be approved by insurers.

Utilization Review Writing

Case Managers use AIP to compose a utilization review note focused on select elements of the patient's chart, which is then verified and forwarded to the insurance company.

Use Case 2AIP for Health Insurance Appeal Management

Manage the intake and review of appeals for denied medical claims efficiently. AIP processes unstructured appeal documents, retrieves corresponding claims data, and generates tailored suggestions for Appeal Coordinators to action in accordance with organizational-approved guidelines
AIP accelerates the validation and review of appeals for denied medical claims by Appeals Coordinators and Medical Professionals.

Appeals Coordinators use AIP to screen lengthy, non-standard appeal PDF documents for information completeness, with AIP leveraging approved rubrics and cross-referencing existing sources of truth for claims. By being able to review extracted data elements with citations instead of having to repetitively navigate lengthy documents, Appeals Coordinators are able to increase their throughput and accuracy during appeal intake.

Appeals Coordinators and/or Medical Professionals can make informed decisions to uphold or overturn the appeal, based on AI suggestions in line with approved organizational policies. AIP compiles appeal responses based on organization-provided template letters and prepares the submissions for processing, streamlining the communication with the appeal originator.
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Verification Assistant Inbox

Appeals Coordinators can easily review and edit essential data elements (e.g. claim id, receive type, urgency, etc.) in context, with direct references to the specific section within the raw appeal. The edits made, with updated citations, are tracked for future reviewers/auditors to reference, making sure valuable expert human context isn’t lost.

AI Integrated Review Inbox

Appeals Coordinators and/or Medical Professionals can use AIP-guided insights to support their decision making on whether to uphold or overturn the appeal. After these users make the final decision, they can work off an autogenerated letter draft using already approved, org-specific templates, reducing their administrative burden and further streamlining the appeals lifecycle.