CLIENT CHALLENGES

Closing Gaps in AI-Based Healthcare Invoice Processing

About a year after their AP solution went live, feedback from early customers revealed some consistent issues. Close to 10 to 12 percent of all invoices were being pushed into exception queues instead of clearing automatically, which meant finance teams at provider organizations (hospitals, clinics, medical facilities, etc.) had to intervene manually.

The most common problems included:

Incorrect or missing purchase order references
Skipped or incomplete invoice line items
Occasionally misinterpreted CPT codes

These recurring breakdowns slowed reimbursement cycles, led to late payments to suppliers, and caused frustration among users who had expected a truly end-to-end AP automation solution.

Here are the challenges this client faced, in detail:

Validation Gaps: The AI layer was extracting invoice fields but not applying strong cross-checks across totals, tax amounts, CPT codes, and PO numbers, leading to frequent mismatches for provider finance teams.
High Exception Load: Around 10-12% of invoices were pushed into exception queues due to unclear line items, vendor mismatches, or duplicate entries. Finance teams had to fix these manually, weakening the promise of fully automated processing.
Misaligned Confidence Thresholds: The platform produced confidence scores but did not apply healthcare-specific thresholds. Clean records were sometimes flagged for review, while genuine errors slipped through, leading customers to question the model's reliability.
Payment Delays and Supplier Strain: Unresolved exceptions slowed approvals, increased late-payment risk, and put pressure on relationships with suppliers that expect predictable payment cycles.
Scaling Concerns: With more healthcare organizations joining the platform, the existing exception rate began to threaten SLAs, platform performance KPIs, and long-term customer satisfaction.

To close these gaps, the client partnered with SunTec Data to strengthen data quality and exception handling through managed invoice processing services, enabling the platform to deliver accurate, compliance-ready invoices at scale.

OUR SOLUTION

Human QA Layer on Top of AI-Driven AP Automation

The client already had an AI-driven invoice processing platform in place. What they needed was a human review layer that could catch edge cases, clean up recurring exceptions, and produce clear, audit-ready outputs that healthcare finance teams could rely on for compliance.

SunTec Data filled this gap by:

Applying field-level checks on key invoice data points
Exception resolution through defined workflows
Producing clear, traceable reports for compliance and audit use

The engagement was delivered by a 30-member team of domain-trained QA professionals, supported by a dedicated project manager.

Human in the Loop Invoice Data Validation for AP Software

Invoice Data Validation

For each invoice processed by the AI engine, our team performed field-level verification of all captured data. This ensured end-to-end data accuracy and resolved the errors that had earlier caused reconciliation issues for healthcare providers.

Vendor Records Validation: Matched vendor IDs, legal names, addresses, and tax registration details against the client’s vendor master dataset to avoid wrong supplier links or duplicate vendor entries.
Clinical Code Validation: Reviewed CPT and HCPCS codes on healthcare invoices to confirm correct usage and mapping, reducing the risk of downstream claim rejections.
Arithmetic Consistency: Verified that unit price and quantity rolled up correctly into line totals, that subtotals matched the sum of all lines, and that tax amounts reflected the stated tax rates.
Low Confidence Review: Any field falling below the AI confidence threshold (for example, OCR slips in invoice numbers or misplaced decimals in medication charges) was manually checked and corrected by QA specialists.

Invoice Exception Management

We set up a dedicated exception handling layer around the platform. This cut down backlogs and ensured healthcare providers received payment-ready, error-free invoices.

Exception Classification: Flagged duplicates, vendor mismatches, missing required fields, and currency or date issues, and assigned clear resolution codes.
First Line Fixes: Straightforward issues, such as correcting date formats or normalizing vendor names, were handled directly by our team before invoices moved forward.
Clear Escalation Rules: When details were unclear, for example, incomplete PO references or conflicting totals, we flagged the record with notes and routed it back to the client so they could coordinate quickly with the provider’s finance team.
Exception History Tracking: We recorded each case and its resolution to build a knowledge base of recurring patterns, helping to reduce repeat exceptions over time.

Shared QA and Exception Reporting

Alongside invoice validation, we set up structured QA and exception reporting for both the client team and their healthcare customers. This gave the platform owner a quantified view of how their healthcare AP solution was performing, while provider finance and compliance teams received documentation they could file directly for audits.

Invoice Throughput: How many invoices were ingested, checked, and released for payment in each cycle.
Exception Breakdown: Rates by issue type (duplicates, missing fields, PO mismatches, code errors).
Resolution Time: Average turnaround for clearing exceptions.
Root-Cause Patterns: Recurring data issues, such as specific suppliers repeatedly sending incomplete invoices.

Security and Regulatory Controls

Given that each invoice contained sensitive healthcare billing information, the entire operation was run under strict, compliance-ready security measures:

ISO 27001:2022 certified processes for all data handling activities.
End-to-end encryption for invoice files, both in transit and at rest.
Adherence to HIPAA and GDPR requirements for PHI and financial data.
Role-based access so only authorized team members could view or process invoice batches.

Project Outcomes

By closing the gaps that appeared after launch, our team helped restore customer confidence in the client’s AI-based invoice automation platform.

Top-Notch Data Accuracy Line-level review of AI output brought invoice accuracy to 99.95%+.

Reduced Exception Queues Exception queues shrank by 80%, with most invoices reaching providers in a payment-ready state.

Reliable Confidence Scoring All low-confidence fields were manually verified, removing false positives and negatives and restoring trust in the scoring.

Scaled Processing without Extra Errors Processing capacity doubled without increasing error rates, proving the platform could scale without sacrificing quality.

SunTec, with their invoice processing services, enabled us to bring our AP automation platform up to the standard our healthcare customers were looking for. Higher accuracy and quicker reconciliation have significantly accelerated platform uptake.

- VP, Product Management

THE HUMAN-IN-THE-LOOP ADVANTAGE

Why Expert Review Still Matters in AI-Powered Invoice Processing

AI can process most invoices at scale, but it still struggles with edge cases, nonstandard formats, and nuanced compliance rules. And in financial documents, even small mistakes, like a single misplaced decimal, a misread CPT code, or an incorrectly mapped vendor record, can have significant impacts. Beyond rework, it exposes providers to compliance violations, reimbursement delays, and supplier friction.

An expert review layer closes this gap—subject matter experts can prevent those consequences by interpreting context, validating high-risk fields, and ensuring that every invoice released from the system is fit for both finance operations and compliance scrutiny.

How We Plug Humans Into the Loop

Dedicated review team layered on top of the client’s AI engine
All low-confidence or ambiguous fields are routed to specialists for verification
Corrections are fed back into the system to train the AI on edge cases

What This Improves

Higher first-pass accuracy and fewer compliance misses
Clean, payment-ready invoices with minimal rework for provider finance teams
Invoices remain automation-fast but audit-ready

In practice, the goal was not to replace AI in this case, but to pair automation with expert oversight. That combination helped position the client’s SaaS platform as a reliable, compliance-ready AP solution for healthcare organizations that need both scale and stability.

Fixing Accuracy Gaps in an Automated Healthcare AP Solution with Invoice Data Validation and Exception Management

A US-Based Healthcare AP Automation SaaS Company