Optimized claims processing improves auto–adjudication rates, turnaround times, and quality levels.
THE CLIENT
Constantly striving to create the best healthcare value for its 35 million members, this national premier provider of health insurance programs sought end–to–end process automation to streamline its operations and pass the associated savings on to its customers.
THE CHALLENGE
Inconsistencies in pre–adjudication processing and multiple–department workflow issues prompted this organization to optimize its data entry procedures and downstream paperless claims form processing, with a focus on increased quality, accuracy and turnaround.
THE RESULTS
SOURCECORP implemented a fully integrated mailroom and pre–adjudication program that includes receipt, opening, scanning, data capture, error resolution, eligibility validations, and benefit–related table–driven knowledge processing tasks. We proactively initiated and fully embraced this client’s Six Sigma methodologies, standards and tools, and supported the technical, process, and personnel transformations necessary to achieve its goals for inline processing, accuracy, and systems workflow requirements.