Each day, healthcare payers get inundated with claims and a significant number (as many as 20%) fail auto-adjudication. Efficiently identifying and processing these exceptions gets harder each year. Business and political pressures on top of the management’s annual grind to identify cost savings are the day-to-day reality.
Historically, payers have had two strategies for claims exception handling:
- Move manual work to low-cost labor markets
- Invest in BPM, queue management systems and web services to speed handling
Low-cost labor markets have been pursued aggressively, both domestically and in language-compatible off-shore markets. The process in a nutshell is: (1) set up a remote location, (2) install the management and infrastructure overhead required, (3) hire and train… then hire and train… then hire and train, and again and again. The grind of working these repetitive and mundane tasks force us into a perpetual recruiting loop. Balancing high turnover and the risks of exposing PHI and HIPAA requirements is also a challenge. Low-cost labor markets have delivered significant savings but not without other headaches and worries.
Separately, technologies introduced over the last 25+ years have eased some of the burden. Workflow systems (1) separate the exceptions, (2) load the work queues, (3) balance the queues and (4) drive processing of the work queue. In essence, these workflow systems, most decades old at this point, push work around faster but low job satisfaction often limits how fast and effective our claims processors are at processing the queues. Unfortunately, we are still limited by human claims processors who, over time, are more prone to errors, sick days, high turnover and low satisfaction. This is not the automated process we envisioned.
Enter the software robot (aka the digital worker)
Much like how mechanical robots revolutionized production in the automotive industry in the 70’s and 80’s, highly configurable “software robots” combine the best of technology and low-cost labor. Designed and configured in weeks, these digital workers can not only work the queue, but also they can sort and assign it as well. One robot can process an entire queue, handling the work of 5 or 10 human workers but without lunch breaks, complaints or sick days.
At last, payers’ claim exceptions can be handled quickly and efficiently with automation that sits atop their existing platforms! Perhaps most importantly is that these digital workers can be “hired” as an operational expense from your day-to-day budgets. You don’t need capital investments typical of other automation solutions.
Seeing is believing! Robotics is real and you need to be solving for it now. Be assured the competition is!
