Benefits are central to the healthcare ecosystem. They bind payers, providers and members together. But payers struggle to manage benefit documents. The data behind the Benefits are used by so many lines of businesses, it tends to be siloed—dispersed across multiple systems—and not stored in a standard way.

This makes it difficult for call centers to get the right information to providers and members.

Traversing between human readable benefits and machine readable claims processing is the fundamental function of a payer’s ecosystem. Traditional payer IT ecosystems have evolved with layers of systems and analysts to address this requirement.

The advent of Natural Language Processing (NLP) and Large Language Models (LLMs) provides payers a unique opportunity to reimagine their traditional workflows and dramatically reduce costs.

To solve this problem, QuantumSim’s BenefitsGPT, standardizes benefits data by using Generative AI. It standardizes data based on a structured knowledge graph that forms the foundation for representing benefits information.