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What is AVA?

AVA, an artificially intelligent virtual assistant, leverages the capabilities of generative AI and machine learning to redefine, streamline and automate payment integrity processes. AVA is highly customizable and integrates seamlessly with existing applications and workflows. With AVA, insurers and providers alike can use intelligent document processing to:

  • Separate a medical record into 18 different categories, including itemized bills using Classify
  • Summarize key data points within structured or unstructured medical records and itemized bills using Capture
  • Query your data using natural language to locate key information anytime through AskAVA
  • Automate claims section and identification of improperly priced claim lines for auditor validation with iBill Recommend

Let AVA be your personal payment integrity assistant

Using CGI’s applied intelligence platform, CGI PulseAI, our team of payment integrity experts, supported by over 30 years of extensive industry knowledge and strategic partnerships, applied their domain expertise to create CGI ProperPay AVA. Through the module, broadly applicable AI capabilities — such as automation, decision intelligence, predictive analytics and conversational AI — become fine-tuned to increase audit team productivity and efficiency. CGI's AI-powered payment integrity solution offers:

Transparency, governance and privacy
Refinement through human-in-the-loop

As part of the responsible use of AI, we’ve built a feature for AVA to learn continually through human feedback. Integration with CGI ProperPay Audit Studio or your audit workflow allows users to provide direct feedback on a case-by-case basis.

Outcomes
  • Increase productivity by up to 500% through review time reduction
  • Optimize processes by up to 25% through automation
  • Maintain a minimum of 97% accuracy with AI outcomes
  • Enhanced claim selection to maximize audit staffing models
Team sitting around table

 

Why CGI for payment integrity?

Our specialized industry experts bring over 30 years of experience in analyzing and auditing government health plans, managed care and private insurance medical data. Our team includes clinicians, data scientists, health information management professionals, payment integrity operations specialists, claims operations specialists and IT experts who bring business experience from relevant healthcare payer industries. We blend CGI professionals from systems, claims, payer, provider and clinical backgrounds to collaborate in developing innovative, outcomes-based solutions.

Our CGI Partners have extensive backgrounds, training and certifications in healthcare management and clinical coding.
 

Ready to learn more about CGI ProperPay - AVA and our payment integrity solutions?

Connect with our team of experts to learn how we leverage technologies such as artificial intelligence, machine learning and natural language processing to predict, prevent and recover improper payments.