AI-Enabled Optical Character Recognition: Transform Manual Processes into Automated Workflows

Fax-based communication and the manual work required to process physical documents remain daily challenges for health plan care teams. Communications related to authorizations, appeals, grievances, and member health still arrive by fax in large numbers, requiring staff to review pages of correspondence and manually re-enter information.

This manual process slows down care decisions, introduces human errors, and creates compliance risks when strict timelines and documentation steps are missed. Manual workflows drive higher administrative costs, drain staff resources, and frustrate both providers and members. The need to modernize is imperative.

Optical character recognition (OCR) has existed for decades, but on its own, it does little more than scan and digitize documents. The real breakthrough comes when OCR is combined with artificial intelligence (AI) and embedded directly into health plans’ patient care workflows— such as authorization and appeal management. Integrating AI-enabled OCR within HealthEdge GuidingCare®, enables the solution to transform faxed documents into structured, actionable data that flows seamlessly into the workflows health plans already rely on. The result is faster decisions, better patient care, greater accuracy, and enhanced compliance.

From Administrative Burden to Intelligent Workflow

GuidingCare OCR removes the friction from processing faxed documents. Instead of staff spending hours manually entering data and searching for the correct member or medical release form to link, GuidingCare OCR provides advanced automation and a guided digital workflow. Staff gain back valuable time, while members and providers benefit from faster turnaround on critical requests such as prior authorizations or appeals.

GuidingCare OCR automates the user workflow and transforms fax correspondence into usable information for health plan workflows through:

• Fax intake and routing: When a fax arrives, it is automatically routed into the HealthEdge® AI platform for digitization and processing. This ensures that documents enter the appropriate workflow quickly, without requiring staff to sort or scan them manually.
• AI-powered data processing: Once inside the platform, advanced OCR and AI models analyze the scanned image of the fax and extract key information. What was once an unstructured scan is converted into structured, machine-readable data that can be applied in workflows.
• Data validation: The extracted data is displayed side by side with the original fax, allowing staff to quickly verify accuracy and make edits if needed. This step ensures that only clean, validated data continues downstream.
• Highlighting and navigation: Each extracted field is linked to its exact location in the fax and visually highlighted. As users review data on one side of the screen, the platform automatically navigates to the corresponding location in the original fax image on the other side. This eliminates extra clicks, making validation faster and more intuitive.
• Automated data entry: After validation, the structured information automatically pre-populates GuidingCare forms such as authorizations, appeals, or grievances. Instead of retyping, staff simply review and move the process forward.

This sequence turns hours of retyping into minutes of guided review, without compromising accuracy or compliance.

Scaling with AI-Enabled Optical Character Recognition

Generic OCR tools stop at digitization. They may scan text, but they don’t understand healthcare workflows or compliance deadlines. GuidingCare OCR is different. It is embedded directly into the GuidingCare solution, so the data flows immediately into the right workflows without requiring manual intervention, separate systems or integrations. It’s specifically designed to meet the unique needs of health plans and their workflows.

Scalability is another differentiator for GuidingCare OCR. This purpose-built solution can process high fax volumes in seconds, enabling health plans to keep up with demand during peak times. It is powered by advanced AI models, including Microsoft Intelligent Document Processing and large language models (LLMs), that can handle handwritten notes as well as multiple languages. And because it is backed by enterprise-grade security and compliance standards such as Health Insurance Portability and Accountability Act (HIPAA) and System and Organization Controls (SOC 2), health plans can trust it with their most sensitive member data.

This combination of utilization management and administrative workflow automation, deep integration, scalability, and security sets GuidingCare OCR apart from OCR solutions that simply digitize.

Measurable Outcomes for Health Plans

The impact of GuidingCare OCR extends across operations, compliance, and member care:

• Staff productivity increases because hours of retyping are replaced with quick validation.
• Accuracy improves, reducing downstream errors that frustrate providers and members.
• Compliance is strengthened, with automation helping plans meet Centers for Medicare & Medicaid Services (CMS) timelines and state requirements.
• Resources can be redirected to higher-value tasks.
• Members can receive faster care decisions, which builds trust and improves access to timely care.

These improvements translate into measurable ROI and tangible benefits for both health plans and their members.

One Part of the HealthEdge Enterprise AI Vision

GuidingCare OCR is tightly integrated into core GuidingCare capabilities. Health plans don’t need to stitch together another standalone tool or retrain staff on a new platform. Instead, they gain automation that works within their existing workflows.

It is one step in HealthEdge’s broader strategy to embed AI and automation into the daily operations of health plans. Fax may still play a role in healthcare, but it doesn’t have to be a bottleneck. With AI-enabled OCR, plans can modernize one of their most persistent manual processes, help reduce risk, and deliver better experiences for staff, providers, and members alike.

HealthEdge is committed to helping health plans make smarter, faster decisions by turning everyday administrative tasks into opportunities for efficiency, compliance, and improved outcomes.

Ready to Modernize Your Correspondence Workflows?

Learn more about how GuidingCare OCR can help health plans automate workflows and accelerate decision-making. Read our data sheet.