The Administrator of the Resources of Colombia's General Social Security Health System (ADRES), in partnership with Blend360, a premier AI services provider, launched PAACME (Procesamiento y Análisis Automático de Cuentas Médicas). The solution automates the processing, analysis, and auditing of medical claims that clinics and hospitals submit for services provided to victims of traffic accidents involving uninsured, unidentified, or hit-and-run vehicles. Coverage also extends to claims arising from terrorist incidents and natural catastrophic events.
As an Anthropic Authorized Reseller for Amazon Bedrock, Blend deployed Claude on Amazon Bedrock, powered by Anthropic, including Claude Opus, Claude Sonnet, and Claude Haiku. These models were extensively used to interpret and structure complex medical documentation, transforming unstructured clinical records into standardized medical and administrative data. The models also enabled the evaluation of medical relevance and coverage across audited claims, the automation of key validations, and the integration of multiple data sources.
PAACME began operations in June and is expected to significantly reduce claims processing times, which can currently exceed four months due to adjustments and objections. ADRES aims to reduce this processing time to less than two weeks, helping improve cash flow for healthcare providers.
Audit processing times were reduced by approximately 96 per cent, decreasing from five hours per case to just 5 to 10 minutes. The cost per audit dropped by nearly 75 per cent, while response times improved by up to 40 times, enabling ADRES to process a significantly larger volume of claims with greater operational efficiency.
At the same time, PAACME strengthened data quality and decision-making capabilities. The use of Claude models improved reasoning over complex medical documentation, achieving 87 per cent accuracy in medical components. The solution also reinforces transparency and oversight by ensuring traceability throughout each validation and safeguarding the proper use of public healthcare resources.
