Saved 50,000 Labor Hours by Reducing 1.5 Million Claims from Manual Review Process
A large national care provider struggled with steadily declining claims auto-adjudication rates due to changes in federal compliance and legislation, human error and inefficient processes and technologies. xScion transformed the manually intensive, legacy claims processing model to an adaptive, real-time automation and analytics platform.
The Challenge
The client needed to make claims processing faster and more efficient and sought to consolidate and automate data management processes while improving compliance reporting. Legacy systems needed to be enhanced with modern reporting and performance metric tools to improve service levels.
The Change
xScion performed a top-to-bottom assessment of business rules, processes and requirements. In addition, the team used Business Process Outsourcing best practices to rewrite business rules, including the automation of rule logics for pending codes/edits and compliance reporting.
Prescriptive analytics were performed on claims data and logic to identify anomalies. xScion then aggregated disparate claims data and created compliance-driven reports to improve automation and accuracy.
The Value
The client now leverages its data to disseminate real-time, predictive and actionable information with claims dashboards, prescriptive analytics and compliance-driven reporting. As a result, auto-adjudicated claims increased by 1.5 million annually, freeing up 50,000 hours of manual review equivalent to 25 full-time employees. Pended claims were reduced by 15%.