Automation eliminates manual data entry between case management and insurance policy admin platforms. It monitors work queues for new policies, and extracts and uses business rules to transform policy application data (e.g., type, payment plan, address). The information is loaded into the target admin platform for underwriting. MI operational reports are generated for completed cases, exceptions, and policy statistics.
Automation applies unapplied payments to client policies. Unapplied funds and open accounts receivable reports are retrieved from the financial systems using the existing reporting tool. Data required is extracted and transformed for use by the process. Using business rules, it searches premium receivable data, matches the payment to the right policy and applies it in the admin system. A management reconciliation report is generated for the processed matches.
Third-parties provide requested data in XML and other file formats. For example, the automation parses and transforms the medical and background information during attribute extraction processing. Within the new business case management system, the automation locates the right insurance policy applications and uploads the transformed data. Case reports are also produced for use by the underwriting team.
Automation finds timecard exceptions, notifies managers and escalates issues. It extracts incomplete timecards from Kronos and uses business rules to identify exceptions. Depending on the reason and circumstances, it signs-off on unapproved timecard or alerts appropriate manager for their action, either in batches or one-by-one. If a manager has multiple employees with issues, the messages are consolidated into a single alert. Over set time periods and until issue resolution, the solution escalates three times (i.e., manager, manager’s manager, etc.).
Automation established a high-volume processing framework to perform initial in-scope service transactions and that was also extensible to rapidly add more service transactions as needed in the future. Solution connects to and monitors the Insurer’s AWD case management system for service requests, applies business rules for handling instructions and makes required adjustments to policies and contracts in the respective admin platforms, including confirming success and closing the case.
A joint client/ WonderBotz team worked closely together to scale InvoiceBotz processing scope by adding more vendors and templates to the existing program. Using existing WonderBotz InvoiceBotz functionality, the joint team identified new vendor invoices to be added, grouped by high and low volume, region, and formats, and expanded the business rules to further verify extracted data to improve confidence levels and OCR data quality.
Automation enables immediate action on referral. Using simplified data-entry screen, intake team and referring physician work together to load the patient’s medical data into the system (e.g., diagnoses, demographics, insurance coverage, circumstances). Using rules and workflows, automation (1) identifies follow-up admission tasks and required face-to-face visits, (2) assigns the direct care service team by location, (3) prepares electronic medical record and (4) provides draft clinical notes to care team for review and submission.
Automation retrieves payroll and timesheet information from ADP and health information systems for each of its staff. It applies business rules based upon worker’s location, schedule, discipline, and assigned patients to calculate the necessary direct and indirect cost center allocations and then loads the results into the financial systems for reporting. A secondary impact, the improved reporting accuracy increased care team utilization.
Automation digitized distribution, collection, and review of timesheets, and eliminated redundant manual data entry. Timesheets are generated from planned provider schedules and also on-demand for unscheduled services. Medical team members receive and fill out their timesheet and are sent reminders to complete them as needed. CPT coding is applied and checked based upon services provided. Finished timesheets are reviewed by Billing before getting uploaded into NetSmart.
Built as a report package within WonderBotz ReportBotz-Plus, this automation eliminates inefficient data gathering while streamlining and preloading financial analyses into report templates. Based upon user-defined business rules, the final analysis is loaded into PowerPoint templates that were designed to enable the team to easily add narrative based upon the monthly happenings. Finished reports are distributed and saved to secure shared drive locations.