3Pillar Showcases Automated Medical Bill Error Resolutions

At AI Unlocked: A Google Cloud x Unqork Innovation Day, 3Pillar showcased a solution for medical billing error resolution that demonstrates what you can achieve by leveraging Unqork’s enterprise application platform and Google Cloud’s AI solutions. Their team was able to build their use case quickly and securely, while unlocking the enormous power of AI-enabled experiences—all with zero code. 

Unqork’s partner, 3Pillar, helps organizations unlock the power of AI and other technologies to compete in the modern digital economy. 3Pillar’s Steve Rowe, Healthcare Practice Lead, and Aneesh Devi, SVP for Partnerships, demoed their team’s solution for medical bill error resolution, which showcases: 

• AI as a key feature of the app functionality
• AI that is effectively integrated into the UI or decisioning
• AI that complements and augments the UI

Watch 3Pillar’s Steve Rowe and Aneesh Devi demo the solution live. 

What 3Pillar built & why

The 3Pillar team decided to tackle medical billing error resolution because it is a two-fold business challenge. First, it too often involves painful and frustrating customer experiences. At the same time, overburdened call center agents end up manually reconciling complex issues and then following up on their cases with internal billing teams and/or payers to ensure accurate  solutions. 

3Pillar showcased the combined power of Unqork’s application development platform and Google Cloud’s AI solutions. Unqork not only accelerates development by eliminating the need to code, but also removes the burden of securing, upgrading, and maintaining across the application lifecycle. Unqork’s GenAI Connector then enables you to quickly integrate with AI providers, like Google Cloud’s

 AI solutions—all within a single view.

And crucially, Unqork makes it easy to ensure HIPAA compliance. Google Cloud’s AI solutions can be deployed in the payer’s environment, while Unqork—trusted by some of the largest organizations in the most regulated industries in the world—secures both the application and connections to backend systems. 

3Pillar’s solution

Combining AI-driven digitization, process orchestration and automation, and human-in-the-loop AI decisioning, 3Pillar’s mobile-first solution leverages integrations to Google’s Gemini models, the payer’s backend customer systems, and email. It drives better experiences for both customers and agents by letting AI do all the painstaking, error-prone work of gathering required information about bills and customer benefits. 

It also uses AI to provide a preliminary decision and determine whether there has actually been an error. It even drafts reports and communications to both customer and providers, which the agent can then review, modify or approve. 

The solution serves three different personas:  

The customer experience

Instead of manually reconciling the medical bill against their health insurance’s explanation of benefits’ statement, and calling the payer customer support line if there’s confusion, the customer simply submits a photo of the bill and a short explanation of any potential problem. 

Google’s Gemini model extracts all relevant data from both the bill, as well as the customers’ explanation of benefits and summary of benefits. Then the model cross-references the bill with benefits details to determine whether or not the bill is accurate. 

If Google’s Gemini model finds that the bill matches the Explanation of Benefits, the customer quickly understands why, as well as a way to follow up immediately if they still have questions. 

If the model does identify a problem with the bill, the solution creates a case and kicks off the process for a customer service agent to conduct a review. 

The customer service agent experience

First, Google’s Gemini model sends a summary of key information to the agent for review. The agent sees the CPTs as well as the error discovered. Then the agent can quickly review the details all in a single window—including viewing the original picture of the bill—rather than toggling back and forth in search of relevant details spread across multiple documents and systems.   

If they do confirm that there has been an error, they just click a button, and the solution generates an email to the provider, including both an automatically generated summary explanation and a link to the log into the application where they need to make any adjustments. 

The provider’s back-office agent 

To accelerate the resolution for the customer, the email is sent to the payer with an explanation and a link that enables them to make the necessary adjustment easily. 

To learn more, watch the 3Pillar team demo the seamless Bill Protector App they built with Unqork and Google Cloud’s AI solutions.