Payer (EPS) · Colombia · Medical claims audit
Colombian EPS (anonymized): AI medical claims audit
18 batches audited with 98 rules across three layers. The human auditor kept the final decision and no communication was sent automatically.
- days, average audit cycle per batch
- 94 → 29days, average audit cycle per batch
- invoice line items reviewed
- 42,300invoice line items reviewed
- lines reviewed manually before prioritization
- 100% → 31%lines reviewed manually before prioritization
- findings with an explicit reason and evidence
- 54% → 96%findings with an explicit reason and evidence
Rounded, anonymized figures.
Read the EPS case