IMPROVING PATIENT OUTCOMES AND CUSTOMER EXPERIENCE WITH 35% REDUCTION OF CLAIMS PROCESSING TIME
MPHASIS JAVELINA, AN INTEGRATED HEALTHCARE PLATFORM ALONG WITH AUTOMATION TRANSFORMS THE USER EXPERIENCE AND PRODUCTIVITY IN CLAIMS ADJUDICATION
One of the industry leaders in health risk management and third-party administration of self-funded health benefit plans, designing strategies to transform the health and wellbeing of individuals, organizations, and communities.
BUSINESS CHALLENGE
The client sought to improve the overall customer experience and improve patient health outcomes. The client's existing claims process was high volume and contained many manual processes. This caused slow turnaround times, decreased accuracy and became a drain on resources.
To provide an exceptional experience and gain user satisfaction, the client identified the need to improve their data collection and claims adjudication processes, which resulted in high rework levels, increased cost, reduced productivity, and drain on resources. The client aimed to improve claims processes' average handling time (AHT) to enhance their productivity, turnaround time, and utilization. In addition, they also wanted to improve the quality of the financial and payment processes while reducing errors and shifting resources to focus on more strategic goals.
The Mphasis team worked with the client to help define their transformational journey and applied lean principles, automation, sourcing, and design thinking to revamp the client's claims processing systems. Mphasis utilized Design Thinking methodology to analyse and identify the organization's 80 % claims-related processes. A detailed workflow map was created to identify areas for improvement. Eliminating manual activity was critical to improving productivity and standardized rules-driven tasks ideal for robotic process automation.
Leveraging the Mphasis processes people, and technology to Identify and quickly apply automation to automate 2 claim types - Accidental and Authorization Claim. This effort increased automation 70%, reduced errors and , greatly improved Turn around Times (TAT).
Before allowing or rejecting the claim charges, we reviewed TPL (Third-Party Liability )and accident letters with additional supplemental documents for accidental claims. We checked whether authorization was approved or denied by the vendor/provider to process authorization claims.
Further, using process analytics, we identified the root causes behind delays in processing specific claims and developed automatic routing of claims to appropriate teams. Finally, we enabled core administrative system changes for straight-through processing to eliminate multiple hand-offs in claims adjudication.
With each optimization lever in concert, we enabled a streamlined, highly automated claims process, including an optimized claims information intake workflow that a single person can manage. Fewer repeat calls requesting information and more automation mean faster disbursements.
We also created a POC and worked on the development and UAT of the RPA infrastructure, which is being used to further define and implement additional automation use cases.
Automation of unmatched and complex claims workflows to increase accuracy and throughput
Over 50% improvement in auto-adjudication rate in four weeks
Reduced per claim time by 30% – 35%
Reduction in errors and Improved quality of Financial and payment process to 99.5%
Projected cost reduction of 40% over the period of 3 years
Improved claims analytics
Increased levels of straight-through processing
Re-allocation of resources focused on improving user and patient outcomes
Increased user satisfaction with the ability to focus on high-value activities