Transforming Healthcare Billing Review with Generative AI
One of the clearest examples of how artificial intelligence is delivering tangible value in healthcare can be seen in a Generative AI–based system developed by Matrix DnA for a major health maintenance organization (HMO).
In many healthcare systems, when a patient is hospitalized, the hospital submits both medical documentation and a payment request to the patient’s HMO. While patients understandably assume that once treatment is approved and completed the financial process is resolved, for the HMO the real work often begins only afterward. Medical review teams, including physicians and interns, are required to manually examine large volumes of hospitalization summaries, compare clinical information with billing requests, and determine whether charges are justified.
This manual review process is time-consuming, costly, and exhausting for medical staff, diverting highly trained professionals away from clinical and research activities and creating operational bottlenecks.
The Solution — Automated Medical Document Validation with GenAI
To address this challenge, Matrix DnA developed an AI-powered medical document validation system that applies Generative AI to automatically analyze hospitalization summaries received from hospitals.
Asaf Timor, CEO of Matrix DnA, explains:
“The system we developed uses GenAI to analyze hospital visit summaries and automatically check medical documents. It identifies whether a billing request is correct or not and provides a clear, reasoned explanation that enables rapid handling of discrepancies and, when required, an expedited appeal process.”
The system performs tasks that previously required intensive manual review:
- analyzing unstructured medical text
- comparing clinical data with payment claims
- flagging inconsistencies and potential errors
- generating structured explanations to support follow-up actions
Impact – Efficiency, Accuracy and Significant Cost Savings
By automating this process, the HMO achieved multiple measurable benefits:
- dramatic reduction in manual review workload for doctors and medical interns
- faster resolution of billing discrepancies
- shortened appeals and correction cycles
- recovery of funds that would otherwise go unnoticed or unrecovered
Most importantly, the system delivers millions of shekels in annual savings, while preserving clinical resources and reducing burnout among medical professionals.
A Broader View – AI as an Operational Enabler in Healthcare
This project demonstrates how Generative AI can be applied beyond clinical decision-making, directly improving the operational and financial efficiency of healthcare organizations. By bridging medical content analysis with administrative processes, Matrix DnA enabled the HMO to scale review capacity without scaling manpower, ensuring both financial integrity and better use of expert medical time.
In Summary
Through the deployment of a GenAI-based document validation system, Matrix DnA helped a major HMO:
- automate complex medical billing review processes
- reduce manual effort across medical teams
- accelerate dispute resolution
- and generate substantial, ongoing cost savings
This customer story highlights how applied AI, when designed around real operational pain points, can deliver immediate and lasting impact in healthcare systems.