United StatesPublic sector2025 – ongoingMaximus
Intelligent document processing and automation for No Surprises Act dispute resolution
Maximus said its automated dispute resolution system closes more than 1,400 cases a day for CMS
Problem
Maximus runs the federal independent dispute resolution process under the No Surprises Act for CMS, which brings a high volume of cases that each need an eligibility check.
Approach
Maximus combined artificial intelligence, robotic process automation and an eligibility rules engine. The solution includes Maximus Intelligent Document Processing, which extracts and combines data from structured and unstructured sources. The eligibility rules engine is a coded set of rules.
Results
Takeaway
The system pairs document extraction with fixed eligibility rules, so only the document step uses AI.
Categories
- Size
- Large enterprise
- Industry
- Public sector
- Business function
- Production and qualityFinance, risk and legal
- Innovation type
- Process innovation
- AI technology
- Predictive analytics and ML
- Adoption
- Built in-house
- Evidence
- Company's own claim
Sources
Source summaries
Maximus describes the AI, robotic process automation and rules-engine system it uses in the CMS federal dispute resolution work. It gives 1,400+ cases closed daily and a median eligibility processing time of two business days.
Full details are in the original sources.