From Manual Entry to AI-Driven Solutions: Revolutionizing Provider Contract Management in Healthcare

In my first job in healthcare, I spent hours manually entering provider contracts into TriZetto FACETS, term by term, from paper documents. It was a slow, meticulous process that highlighted the critical need for accurate data management. Today, the healthcare landscape has evolved, and so have the tools we use to tackle its challenges.

At HealthRate, we’ve developed an AI-driven solution specifically designed to interpret and ingest provider contracts, a task that’s historically been complex, time-consuming, and error-prone. Here’s how it works:

1. Extract text from PDFs: We start by pulling text out of provider contract PDFs.
2. Break text into manageable chunks: The extracted text is divided into smaller, digestible sections.
3. Interpret contract terms with LLMs: These chunks are processed by specialized Large Language Model (LLM) functions, each tailored to interpret a single contract term.
4. Validate responses: The outputs are carefully validated for accuracy.
5. Load into our data model: The validated data is then integrated into our data model.
6. Human-in-the-loop review: Finally, a human review step ensures quality and precision.

This approach has proven its value. We’ve successfully interpreted and ingested thousands of provider contracts, freeing up our team to focus on higher-value work rather than manual data entry.

Lessons Learned Building with LLMs

Through this process, we’ve gained key insights into working with LLMs effectively:

• Data security is non-negotiable. We exclusively use locally hosted models to protect sensitive information.
• Clean data still matters. Thorough preparation significantly improves outcomes.
• Pick the right model for the task. Experimentation is essential to find the best fit.
• Context is key. We test different chunk sizes to optimize performance.
• Break it down. Small, focused tasks yield better results from LLMs.

Healthcare is inherently complex, but with the right tools, we can simplify and accelerate the work that matters most. Our solution not only streamlines provider contract management but also sets the stage for more efficient, data-driven operations.

Curious to learn more? Let’s connect: healthrate.io.