Nagai Hospital Reduces Person-Dependency in Operations by Implementing AI Medical Claim Support Tool "Reze"

mutex Inc. (Headquarters: Bunkyo-ku, Tokyo; CEO: Kohei Kumazawa) has released a case study on the use of its AI medical claim support SaaS, "Reze," at Nagai Hospital (Location: Mie Prefecture).

The hospital decided to implement the tool to manage claim denials and reassessments, reduce the burden of preparing detailed patient condition notes, and resolve the intense workload concentration at the end and beginning of each month. This has led to the creation of a team structure with a clear operational outlook and a better working environment for medical administrative staff.

Background for Implementation: Person-Dependency and Month-End/Beginning Workload Concentration

For many years, the hospital's medical claim processing relied on a "person-dependent operation" model, contingent on the experience and knowledge of specific staff members. At the end and beginning of the month, claim processing, denial responses, and confirmation of patient condition notes were concentrated in a short period, creating a significant workload for the staff.

The workflow involved many manual tasks, and progress was managed using Excel or paper, creating a constant risk of missed items and errors. A significant amount of time was also required to create detailed patient notes, making structural improvement an urgent issue from a sustainability perspective.

The hospital addressed these challenges from a "Medical DX Promotion" viewpoint and began selecting a tool to visualize, standardize, and automate its medical claim operations.

Deciding Factor for Implementation: A Field-Oriented Co-Development Process

Reze is a service that was developed and shaped according to the needs of the frontline, initiated when the hospital shared its challenges with mutex Inc. Continuous dialogue and improvements were made based on practical issues such as the complexity of handling claim denials, the burden of creating patient notes, and concerns about billing omissions.

The hospital cited the following three reasons for its decision:

- The service was shaped jointly, originating from our hospital's specific challenges. - The development team repeatedly conducted on-site interviews and continued to make improvements along our actual workflow. - The speed from prototype to implementation was fast, and we can expect continuous evolution.

During the development process, a mutual understanding between the engineering and frontline teams was carefully established, creating a two-way communication channel adapted to the rhythm of a busy medical site. The hospital commented, "It's not just about speed; it's about high-quality iteration that respects the frontline."

Implementation Effects

- **Smoother Management of Claim Denials and Reassessments** Progress management, previously done in Excel, is now completed within Reze, making it easier to assign tasks and check their status. The risk of missed items has been reduced, facilitating division of labor within the team.

- **Reduced Burden of Creating Detailed Patient Notes** The process has shifted to reviewing and correcting AI-generated text, shortening the time required for creation. The saved time can now be allocated to other claim-related tasks.

- **A Stable, Team-Based System** By visualizing the progress and assignment of tasks, the team can now proceed with work systematically with a clear outlook, even during the busy month-end/beginning period. Person-dependency has been resolved, creating an environment where staff can more easily concentrate on their core duties.

Excerpt from a Comment by the Director of Nagai Hospital

The introduction of Reze has not only improved operational efficiency but has also served as a catalyst for a more positive review of our work styles. With more aspects supported by the system, an environment has been established where staff can easily focus on the tasks they should be concentrating on. The vision of "complete automation of medical claim processing" that Reze advocates for is continuous with the challenges we have felt on the ground, and we want to continue to work on frontline-based improvements and the promotion of Medical DX.

(Dr. Kozo Hoshino, Director, Nagai Hospital)

About Reze

"Reze" is an AI medical claim management SaaS for medical institutions provided by mutex Inc. It supports the efficiency and revenue optimization of medical claim operations through functions such as denial/reassessment management, AI-automated generation of patient condition notes, and AI claim checks. It provides three values: "Revenue Improvement," "Work Style Reform," and "Management Improvement," and aims for the "complete automation of medical claim processing" by an AI agent in the future.