DentalXChange and AWS Partner Quantiphi Harness AI to Modernize Claims Form Processing

Claims processing in the dental industry is often complex and cumbersome, involving a significant amount of paperwork and coordination among dental providers, insurance companies, practice management software, and patients. DentalXChange streamlines this process through its electronic data interchange solutions, which automate the submission and tracking of dental claims. Serving nearly 90,000 dental offices, the company’s RCM platform automates the exchange of critical data, which reduces administrative overhead and improves the speed of payment processing.

Previously, DentalXChange used an OCR solution that processed every ADA claim or account statement form using a corresponding template. However, with a vast array of form variations across thousands of dental offices, managing and updating these templates was both time consuming and labor intensive. The OCR solution often failed to accurately capture all the information contained in a form, and humans needed to review the documents and decipher the affected fields. Up to 40 percent of these forms required additional checks, which added hours of downstream processing. Because the solution was dependent on static templates, DentalXChange could not efficiently scale document processing to adapt to fluctuating demand. “Keeping the templates up to date was a constant task, and the output data needed a high degree of verification, requiring human-in-the-loop workflows to ensure accuracy,” says Navin Narayanan, chief technology officer of DentalXChange.

The OCR solution fell short of delivering the accuracy and efficiency that DentalXChange required, and the company knew that it was time to modernize. To stay ahead of the competition, the company wanted to take advantage of cutting-edge technologies, such as AI/ML. DentalXChange chose to transform its claim processing approach on Amazon Web Services (AWS) with the help of AWS Partner Quantiphi.

Quantiphi's expertise in AI and machine learning, combined with its ability to deliver enterprise-scale solutions, made the company the ideal partner for this transformation. Using robust cloud infrastructure on AWS, Quantiphi implemented its Qdox solution, which automated the entire claims processing workflow and significantly improved accuracy. This collaboration empowered DentalXChange to efficiently scale its operations to manage 30 million dental claims annually, reduce the reliance on manual review, and achieve its goals while managing expenses effectively.

Working together, Quantiphi and DentalXChange developed a custom document processing solution that accurately extracts information from ADA claims forms, powered by Qdox. Available through the AWS Solutions Library, Qdox makes it simple for businesses to extract key information from a variety of documents and use the data as required. Amazon Textract—an ML service that automatically extracts text, handwriting, layout elements, and data from scanned documents—provides the foundation for these capabilities.

By replacing the rigid, template-dependent OCR method with AI/ML, DentalXChange facilitated more accurate and efficient data extraction. All input and output files are stored on Amazon Simple Storage Service (Amazon S3), an object storage service built to retrieve any amount of data from anywhere. The solution uses AWS Lambda—a serverless, event-driven compute service—to convert the files into the appropriate formats and invoke Amazon Textract.

Amazon Textract then extracts and processes information from the forms with high accuracy. Using custom ML models built into Amazon Textract, the solution can better understand various data types, such as key-value pairs and tables, and efficiently process the structured and semistructured data found in claims forms. Confidence scores are generated for each piece of extracted information, which helps DentalXChange validate the reliability and integrity of the data.

Amazon Elastic Compute Cloud (Amazon EC2), which provides secure and resizable compute capacity for virtually any workload, is used to validate input images and build Docker images for speedy deployments. Amazon Elastic Container Service (Amazon ECS), a fully managed container orchestration service, dynamically scales the solution as needed through automatic scaling. With these automatic scaling capabilities, DentalXChange can more efficiently allocate its resources, scaling up to process high volumes of documents and scaling down as demand decreases.

With a custom document processing solution powered by Qdox, DentalXChange can process a large volume of documents responsively, accurately, and dynamically—all while minimizing its administrative overhead. The company can automatically extract data from ADA claims forms with 98 percent or higher accuracy, a substantial improvement compared with its OCR-based method. “Quantiphi’s intelligent document processing empowered us to handle claims quickly and efficiently, reducing human effort from 40 percent to just 1 percent,” says Narayanan. “We can handle a large volume of documents with greater responsiveness, accuracy, and scalability, while significantly minimizing the overhead involved in processing.”

DentalXChange has drastically reduced labor costs and sped up processing, handling more claims efficiently. The company reduced operational expenses and improved performance by replacing Amazon ECS clusters with serverless AWS Lambda. DentalXChange also reduced database infrastructure costs for Amazon Relational Database Service (Amazon RDS), an easy-to-manage relational database service. And with less time spent on manual reviews and data entry, DentalXChange’s employees can focus more on customer service and other value-added activities.

Using AI/ML, the solution identifies the type and variant of each document and adjusts the extraction process accordingly. With this flexibility and scalability, DentalXChange can rapidly adapt to changes in claim form formats, which removes the need for constant manual template updates. Thanks to these improvements, the company can handle a higher volume of claims at a faster pace; it can complete certain tasks in a few seconds as opposed to the hours that it required previously, which has enhanced the overall customer experience.

Now, Quantiphi is continually monitoring and optimizing the document processing solution. The AWS Partner is refining the AI/ML models for even greater accuracy and efficiency, and working with DentalXChange to incorporate responsive, accurate, and scalable support for additional documents. As technological advancements are made and AI/ML models are optimized, DentalXChange’s document processing capabilities will remain dynamic and adaptive.