The Challenge
Like many healthcare payers, BCBS was challenged with increasing pricing pressures while struggling to staff the roles needed to process claims. A previously deployed solution that included traditional OCR no longer met their needs, to continue to remain competitive, they needed to change how they thought about their processes.
The Solution
After an extensive RFP process that included more than 70 candidates, the combination of Naviant’s industry process expertise and automation technology was selected to drive efficiency.
The Scope of Work
The previously deployed OCR software was struggling to keep up with the changing landscape. The results were often incorrect and needed manual intervention to get clean data from them to process the claim to meet their SLA’s.
Based upon their extensive experience, Naviant provided a comprehensive review of their processes in conjunction with ABBYY’s award winning AI-based Intelligent Document Processing technology. While the primary focus was on CMS-1500, UB-04 and ADA document types, the solution was extended to 50 additional document types, including correspondence, appeals, surveys and more.
Value Statement
There are several areas for process improvement through automation, including but not limited to:
- Elimination of manual pre-sorting of documents.
- Straight Through Processing of claims to speed the adjudication; focused on improved customer satisfaction.
- AI-Based, Machine Learning Engines to continually improve the capture of claims data and minimize human interaction.
- Automatically ingest the captured data as an EDI 837 transaction and documents as searchable PDF’s.
- Reporting data to identify potentially missed deadlines based upon different SLA’s.
- Recognition of $1.6M in annual savings by repurposing human capital to other more important areas of the business.
