enhancing REIMBURSEMENT SERVICES with rpa
Client Introduction
Health Choice is a Phoenix-based managed care organization delivering healthcare services through health plans, integrated delivery systems, and managed care solutions. Health Choice offers comprehensive, coordinated care to more than 200,000 Medicaid members and 8,700 Medicaid and Medicare dual-eligible members. Health Choice is a subsidiary of Blue Cross Blue Shield of Arizona.
Who They Are
Blue Cross Blue Shield of Arizona (BCBS AZ) is a leading healthcare insurance provider offering health insurance and related services to more than 1.7 million customers.
Key Challenges
BCBS AZ faced significant challenges in managing a high volume of medical claims efficiently. The Reimbursement Services department was burdened with repetitive tasks, leading to overtime work and operational bottlenecks. They needed a robust solution to automate claims processing and data management, thus enhancing data integrity and reducing manual errors.
High volume of repetitive tasks
High volume of repetitive tasks
High volume of repetitive tasks
Inefficient manual processes
High volume of repetitive tasks
High volume of repetitive tasks
Operational bottlenecks
High volume of repetitive tasks
Operational bottlenecks
Staff working overtime
High volume of repetitive tasks
Operational bottlenecks
We had a lot of people doing repetitive tasks and working overtime
Matthew Kingry, VP of Reimbursement Services, BCBS AZ
The RPA Solution
Health Choice trusted SNAP Consulting to implement Nintex RPA LE for handling the high volume of CMS-1500 claims. Thanks to the rapid deployment capabilities of Nintex Foxtrot RPA, SNAP Consulting successfully developed and launched multiple solutions, extending their application to various claim types, including dental and ambulance claims.
SNAP Consulting has since deployed over 100 customized RPA solutions to significantly minimize human intervention while ensuring precision. These solutions enhanced operational efficiency and productivity.
Focus on Reimbursement Services
The Reimbursement Services department at BCBS AZ saw extensive benefits from RPA, touching all processes from claims to maintaining member and provider profiles, adjustments, and disputes.
- Specific Improvements:
- Claims Processing: Automated claims processing improved accuracy and efficiency, handling an average of 5,000 claims per day.
- Member and Provider Profiles: RPA ensured accurate and timely maintenance of profiles.
- Adjustments and Disputes: Reduced manual intervention led to faster resolution of adjustments and disputes.
Key Adaptations
Process Automation
Automate end-to-end claims processing, reducing processing time per claim and freeing up staff for more complex tasks.
Data Management
Seamless integration with existing systems ensured up-to-date and accurate records
Error Reduction
Substantial decrease in data entry errors, resulting in more reliable data and reduced need for manual corrections.
RPA touches all our processes in the Reimbursement Services Department. From claims to maintaining member and provider profiles, RPA is involved from start to finish, significantly improving our accuracy and efficiency.
Matthew Kingry, VP of Reimbursement Services, BCBS AZ
Results and impact
Quantitative Outcomes
Lessons Learned and Future Outlook
Lessons Learned and Future Outlook
Claims Process Volume: 400% increase
Processing Time: 50% reduction
Cost Savings: Over $1.2 million annually
Full-Time Employee Equivalent (FTEE): RPA performed the work of over 30 FTEEs.
Lessons Learned and Future Outlook
Lessons Learned and Future Outlook
Lessons Learned and Future Outlook
The success of RPA at BCBS AZ highlights the scalability and flexibility of automation. This project has set a precedent for expanding RPA applications within BCBS AZ and other healthcare clients, promising further improvements in efficiency and cost savings.
SNAP Consulting - Case Study - BCBS AZ & Reimbursement Services (pdf)
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