Friday, February 8, 2008

Automation could speed VA claims

AI to help process VA Claims faster

Artificial intelligence — already used to process private-sector insurance claims, handle banking transactions and double-check medical procedures — might be the solution to help veterans get their benefits faster.

Advocates do not envision technology completely replacing humans in deciding complicated disability benefits claims, but a computerized system could look at key elements of claims and at least make a preliminary recommendation about whether to approve or deny them.

Such a system is already being tested and could be ready for wide use within a year.

Such a system could reduce claims processing time from months to just a few hours, with fewer errors, fewer lost records and less frustration, a panel of experts told the House Veterans’ Affairs disability assistance and memorial affairs subcommittee Jan. 29.

Tom Mitchell, a computer science professor at Pittsburgh’s Carnegie Mellon University, said veterans benefits are exactly the type of records that artificial intelligence can help manage.

“Claims processing at the Veterans Benefits Administration appears to be amenable to a variety of improvements through the introduction of more computerized operations, including the adoption of artificial intelligence technologies for rule-based processing, case-based reasoning and data mining,” Mitchell said.

Commercial insurance claims are routinely processed online and automatically, Mitchell noted. One health insurance company “processes over 90 percent of its insurance claims for hospital and physician services automatically, with no human intervention,” he said.

The subcommittee chairman, Rep. John Hall, D-N.Y., holds out hope that using computers to determine simple benefits claims would reduce the time it takes for veterans to receive a ruling on a claim, which now averages 177 days and can take far longer.

“I envision a VA in which a veteran can apply online for benefits, upload records, exams and other certificates, which are prioritized and classified by an expert system that can match the data to the rating schedule criteria and shorten the time it takes to generate a claim,” Hall said, adding that a system could pick out key words to calculate a disability rating.

To underscore the importance of finding a more efficient way to process claims, Marine Gunnery Sgt. Tai Cleveland, paralyzed after an August 2003 training accident in Kuwait, and his wife, Robin, told the subcommittee of their five-year battle to get disability, housing and vehicle benefits — a course blocked by confusing rules, lost records and poor communication.

“We filed and refiled, submitted and resubmitted, medical records, claims forms, applications and so on, but no one seemed to be able to track anything, placing additional burdens on an already overwhelmed family,” Robin Cleveland said. “Only after the intervention of a congressional office and a nonprofit organization were we able to get the benefits Tai had earned. This process should not be this hard.”

The financial and emotional toll on the family was “crushing,” she said, noting that the couple’s two children had to drop out of college at one point because the family could not afford it.

“We are going to do everything we can to help you and to make sure this doesn’t happen to others,” Hall told the Clevelands.

Hall said VA has responded to the increasing backlog of claims by hiring more claims processors, but it takes two years to hire and train a new employee — who, once fully trained, can handle only two or three claims a day. And many new hires leave after five years, forcing VA to recruit and train anew.

Rep. Doug Lamborn, R-Colo., the subcommittee’s ranking Republican, said some of the Clevelands’ problems could have been solved if Defense Department and VA records were digitized so complex claims could be shared by more than one VA office, and could be easily replaced if lost — which seems to be a major problem for veterans.

Kim Graves, VA’s director of business process integration, said VA “has made significant strides in the use of information technology to improve claims processing in all of our benefit programs.”

Graves said VA is working on a paperless benefits delivery initiative. In a pilot project, a service member’s separate medical records and supporting claim information are digitized at the start of the claims process.

Graves apologized to the Clevelands, and offered to help with any outstanding issues they face.

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