Save 20+ Hours Monthly with AI-Powered Insurance Coverage Verification

Healthcare billing can be a complex maze of decisions and verifications that consume valuable time better spent on patient care. The DocStation AI™ Payer Prediction Model is transforming this landscape by streamlining the medical claim submission process with remarkable accuracy and efficiency.

DocStation AI™️ uses prescription coverage details, human-in-the-loop data, and over 40 years of expertise in the healthcare marketplace to accurately predict your patients’ medical coverage. Formerly a neural network machine learning model, the new large language model (LLM) assesses regional impact, subscriber ID trends, and frontline experience to help DocStation users save 20 hours per month or more on medical claim workup and submission – all with higher than 90% accuracy.

This feature is called the Payer Prediction model, and it enables DocStation’s Automated Billing for medical claims to run seamlessly in the background of day-to-day pharmacy workflow while generating revenue for the vital services pharmacists provide.

The Challenge of Medical Claim Submissions

Consider Sarah, a clinical pharmacist at a busy independent pharmacy. Before DocStation AI, she would spend hours each week trying to determine the correct medical payer for her patients’ claims. For just one patient receiving a vaccine, she might need to:

  • Call multiple insurance companies
  • Navigate through various coverage verification portals
  • Cross-reference pharmacy benefits with medical benefits
  • Manually input and verify subscriber information

This process could take 15-30 minutes per patient – time that could be better spent providing clinical care.

Enter DocStation AI™ Payer Prediction

When a DocStation Pharmacy has Auto-Billing configured, medical claims are automatically generated based on targeted medication dispenses. DocStation AI™️ considers the pharmacy coverage to which the medication was billed and predicts up to three medical payers under which the patient is likely to have active coverage.

Then, DocStation AI™️ performs an automated eligibility check to verify active coverage with the most likely prediction first, then on to the second and third predictions as needed. When a successful coverage is determined, the claim is automatically queued to submit to that payer.

Here’s what it looks like:

When the automated eligibility check determines active coverage, the payer will be set on the claim and show as Verified in the payer list.

When the automated eligibility check is unable to determine active coverage, the predicted payers will show as Recommended in the payer list.

DocStation’s innovative LLM-powered system has revolutionized this process by leveraging:

  • Prescription coverage details
  • Regional insurance trends
  • Subscriber ID patterns
  • Real-world billing expertise
  • Human-in-the-loop validation

The result? A system that predicts the correct medical payer with over 90% accuracy, saving pharmacies an average of 20 hours per month.

Real-World Impact

Let’s look at how this works in practice:

Scenario 1: Routine Vaccine Administration

When a Medicare patient comes in for their annual flu shot, DocStation AI automatically:

  1. Analyzes their pharmacy benefit information
  2. Predicts Medicare Part B as the primary medical payer
  3. Verifies coverage in real-time
  4. Queues the claim for immediate submission

Scenario 2: Complex Coverage Situations

A patient presents with commercial insurance for a specialty medication administration. DocStation AI:

  1. Evaluates their pharmacy coverage
  2. Predicts potential medical payers in order of likelihood
  3. Performs automated eligibility checks
  4. Either verifies coverage or provides ranked recommendations for manual review

How to Let DocStation Choose for You

Enabling Auto-Billing with DocStation AI is straightforward:

  1. Configure Auto-Billing settings for your pharmacy
  2. Select which services to include in automated claim generation
  3. Let DocStation AI handle the rest

The system will automatically:

  • Generate claims based on targeted medication dispenses
  • Predict and verify up to three potential payers
  • Queue verified claims for submission
  • Flag claims needing additional review with recommended payers

Future Developments

DocStation AI™ continues to evolve, with upcoming improvements addressing common challenges such as:

  • Missing alpha prefixes in subscriber IDs
  • Relationship mismatches with policy holders
  • Discrepancies between pharmacy and medical benefit IDs

The Bottom Line

By implementing DocStation AI’s Payer Prediction model, pharmacies can:

  • Reduce administrative workload by 20+ hours monthly
  • Increase claim submission accuracy
  • Improve cash flow through faster claim processing
  • Focus more time on patient care
  • Generate additional revenue from clinical services

This powerful tool represents the future of pharmacy billing automation, making it easier than ever for pharmacies to receive compensation for their vital clinical services while maintaining focus on what matters most – patient care.

For specific questions about the LLM or training data, DocStation’s Support team is readily available through the Chat feature or you can reach out to us here.