We Can Help
Health care providers need easy access to information about co-insurance, deductibles, authorization requests, exclusions, conditions, co-pays, out-of-pockets, referral requirements, and benefit maximums. Right now, contacting insurance companies to get all these answers costs health care providers billions of dollars per year.
But it is possible to streamline this process and make staff members’ lives easier while saving health care providers time and money every year.
Sensentia’s leading-edge AI technology supports provider systems to streamline the benefit verification workflow, determine eligibility, patient responsibility and authorization requirements – reducing the number of calls to health payers, and decreasing the amount of time it takes to get questions answered. Our baseline capability can be adapted to meet provider needs and configured to support a payer’s in-network and contractor providers.
Providers can use natural language and CPT codes to make inquiries using an easy-to-use interface – and Sensentia’s artificial intelligence will return rich, detailed, actionable responses.
With Sensentia, providers can complete benefits research for medical, dental, vision, and pharmacy services in half the time, with 99+% accuracy.
IMPROVE CUSTOMER SERVICE
We help provide a superior customer service experience with transparent, fast and accurate benefit information. Imagine if your call center could easily connect seniors to the right resources for their finances and health and provide a superior customer service experience with transparent, fast, accurate information delivered at every step. Your senior members would be fully supported, whether they’re using self-service options, submitting mobile inquiries, or talking with your reps on the phone.
COORDINATE DUAL ELIGIBLE BENEFITS
Sensentia’s AI solution improves coordination of benefits for the nation’s 11 million individuals that are dually eligible for Medicare and Medicaid – often the highest-need populations in either program. Sensentia supports Dual Eligible Special Needs Plans (D-SNPs) and their members by helping them resolve operational challenges for navigating disjointed benefit systems.
Our AI-powered benefits comparison solution visually displays side-by-side benefits for Medicare/Medicaid comparison available for contact centers and member self-service. With this benefits comparison solution, plans can resolve member calls more quickly and accurately, improve their readiness and capacity, and better coordinate and integrate Medicare and Medicaid benefits.
GUIDE SUPPLEMENTAL BENEFITS
Sensentia’s AI solutions efficiently guide seniors on their supplemental benefits such as transportation, OTC, dental, vision and more. Medicare Advantage supplemental benefits address the non-clinical social determinants of health for people with acute health needs or chronic illnesses. While supplemental benefit offerings are not necessarily health-related, health insurance plans recognize their importance for lowering costs and driving better health outcomes.
IMPROVE RATINGS AND SATISFACTION
Sensentia helps plans achieve high ratings by closing gaps in care, improving member satisfaction, decreasing disenrollment and reducing administrative costs by providing real-time answers to complex questions. When senior members’ expectations are met, and CSRs provide the help people need while being courteous and respectful, it naturally leads to better CAPHS scores and Star Ratings.
INCREASE CONNECTIVITY AND HEALTH ENGAGEMENT
With Sensentia’s technology, every interaction with a senior is an opportunity to encourage them to leverage their benefits and take action in improving or maintaining their health status. By creating a delightful customer experience and proactively addressing senior’s needs and concerns, payers can help close the gap in care with every interaction. Sensentia solutions lead to happier CSRs, higher member retention, and profitable growth for health plans – and most importantly, better health for seniors