Automating Claims Management in a value-based health care system helps clients achieve 65% reduction in Claims Backlog
Industry: Healthcare Provider
65% Reduction in claims backlog
75% Reduction in processing time
Client Overview:
One of the fastest-growing children’s health organizations in the US trying to implement value-based care models
Increased customization crucial for value-based care model increased complexity of Automating payment system
The shift from fee for service model to a value-based care model results in the plurality of plans available which in turn results in increasing complexity of automating the payment system owing to the increased customization.
The client saw an opportunity to address its difficulties with the required processing of a monthly data load that was error-prone, time-consuming, and costly and engaged AiRO to increase claims processing throughput using automation.
AiRo’s Process Automation Solution Wins Client's Confidence
AiRo worked with the health system’s payers and the client to create a uniform set of data input that could be used for automated claims filing regardless of the customized plan. The team then created an automated system to fetch the required data from various sources based on the requirements of the plan.We implemented our Process Automation solution to process the low-to-medium complexity work that represents the bulk of claims received and tuned it to process many common edits.To address the issues with the file data load, our team helped clean the data and fine-tune automation processes to load the files and reduce the amount of human intervention required.
The Client Recorded Significant Gains Post Solution Deployment
65% Reduction in claims backlog
75% Reduction in processing time
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The AiRo Perspective
AiRo worked with the health system’s payers and the client to create a uniform set of data input that could be used for automated claims filing regardless of the customized plan. The team then created an automated system to fetch the required data from various sources based on the requirements of the plan.
