A US healthcare payer
Claims and enrollment adjudication in 2 minutes, not 30.
Payer-side claims and enrollment forms read, checked and adjudicated on the Cogniquest platform, at 2,000 forms a day.
- 30 min → 2 minPer form
- 2,000Forms a day
The challenge
Every claim and enrollment form had to be read, cross-checked and adjudicated by hand. At 2,000 forms a day, that meant about 30 minutes of skilled work per form.
How it works
- 01Built as an outcome on the platform
The adjudication workflow was composed on the Cogniquest platform: documents read and checked by deterministic components, with judgment applied only where a step needed it.
- 02Governed by design
Every determination carries its record, so reviewers see what was checked and why, and the payer stays in control of exceptions.
The results
| Measure | Before | After |
|---|---|---|
| Time per form | 30 minutes | 2 minutes |
| Daily volume | — | 2,000 forms |