Automated Claims Processing

Overview

Development stage

DeployedSource: c) Deployed – The use case is being actively authorized or utilized to support the functions or mission of an agency.

High-impact designation

High-impactSource: a) High-impact

Impact justification

Not reported

Start date

Not reported

Withheld from public reporting

Not reported

Mission

Topic area

Government Benefits Processing

Operational functions

Document processing and extraction, Claims and case processing, Public-facing customer service Derived by keyword rules; see methodology

Problem the AI is intended to solve

The purpose of the AI is to automate aspects of NCA benefits and application processing to decrease the case processing time and increase the customer service delivered to Veterans and their next of kin. Currently, it is applicable to the Pre-Need and Presidential Memorial Certificate programs. In the future, other business lines may be included, such as the Headstones, Markers, Medallions, and Urns and Plaques programs. This benefits NCA by automating aspects of the workload (data entry, case creation, document digitization, letter creation, and status updates).

Expected benefits

The outcomes support expedited service delivery of benefits to Veterans and their next of kin. About 30% of Veteran applicants receive their Pre-Need eligibility determinations within 24 hours, without human intervention.

System outputs

The Hyperscience platform (optical character recognition (OCR), natural language processing (NLP), and machine learning (ML)) extracts document data, uses application programming interfaces (APIs) to query data from other VA systems, and applies robotic process automation (RPA) to enter data into existing legacy NCA systems: Eligibility Office Automation System and Web Presidential Memorial Certificates. As the case is processed, automation creates documents that combine relevant claimant information (for use by claim agents), updates statuses, and creates letters, as appropriate. No original content is created through these processes.

Technology

AI classification

Natural language processingSource: Natural Language Processing: AI that processes, interprets, and shares information in human language.

System name(s)

Not reported

Custom-developed code

Yes

Public source code

Not reported

Sourcing

How it was built

Purchased from vendorSource: a) Purchased from a vendor

Vendor (as reported)

Not reported

Vendors (standardized)

None on the standard list

A vendor is the supplier named by the agency. It does not identify the underlying model or AI technology.

Data and privacy

Involves PII

Not reported

Privacy Impact Assessment

Not reported

Authorization to Operate

Not reported

Demographic features

Not reported

Training and evaluation data

Not reported

Federal Data Catalog

Not reported

Governance

0 of 8 minimum-practice questions answered. A blank answer means the agency reported nothing; it does not mean the practice is absent.

Potential impacts and how they were identified

Not reported