A leading national third-party administrator (TPA) of customized self-funded health plans serving employers and brokers.
BUSINESS CHALLENGE
The client’s objective was to enhance customer experience, automate scale, and streamline their back-office operations for quote-to-claim processes. They wanted to structure the data for the quote process and free up their critical resources as they were handling a large volume of inbound claims, which were in different formats and lacked consistency in the document structure. This manual data analysis was costly, low on accuracy, and led to delays in customer queries. The client aimed to respond to its customers in near-real-time, reduce resource drain and prevent inconsistent responses to customer queries.
Mphasis partnered with the client, analyzed the existing processes, and proposed implementing Mphasis' DeepInsights™ Solution, a cognitive automation platform that enables enterprises to gain faster and more effective access to insights from data. This platform can automate processes, ingest the incoming forms, and perform checkbox identification and text extraction from HCFA, UB, and Dental claim forms.
We created the appropriate key-value pair to enable business intelligence through structured data. Enabled integration of claims data with the internal system using EDI 837 protocol.
Enhanced data analysis accuracy through a powerful cognitive engine automatically leverages the best of machine learning and deep learning algorithms
Implemented cloud-based solution to provide the most contextual and accurate decision metrics from structured and unstructured data
Enables timely decision-making by exponentially reducing the turnaround time of business processes by 50%
60% improvement in productivity and achieved high-level accuracy by enabling working with multiple file formats and types and presenting information in a structured format for downstream consumption
