Are customer experience demands in the age of digital disruption coupled with an aging workforce restricting you from delivering a seamless and personalized experience?
Has COVID-19 deepened pre-existing challenges of reducing costs while optimizing patient outcomes and ensuring compliance?
Automating your operations is your answer. COVID-19 is having a significant impact on the Health Plan industry due to workforce challenges and uncertainties surrounding treatment coverage, claims coding, billing, and adjudication. To top it all, the Centers for Medicare & Medicaid Services requires Health Plans to standardize payer-to-payer data exchange by 2022 and implement APIs for patient-data sharing by early 2021...
Intelligent Automation – a combination of Robotic Process Automation (RPA), Machine Learning, and Artificial Intelligence (AI) – is a lever that can help address these challenges and enable Health Plans, to thrive in this volatile business environment.
While most Health Plans have deployed automation, narrow goals focused on improving back-end processes have limited its value. Broadening the scope of automation to include patient outcomes significantly increases ROI for Health Plans.
Predictive insights for faster, more accurate decisions
Lower costs, higher efficiency, and productivity
Greater security around PHI lower human intervention
Improved quality, safety and regulatory compliance
Interoperability & integration between heterogeneous systems
Increased agility and scalability to meet variable demand
For Health Plans, success in the post-COVID era will depend on enabling telework, agility, scalability, and continuity. Firstsource offers Automation as a Service (AaaS) across front and back office functions to achieve these objectives.
From automating customer service operations to functions such as enrollment and billing, claim operations, provider network management, finance and accounting, and human resources, our Intelligent Automation solutions empower you across the value chain.
We offer agile solutions by leveraging our deep domain experience and technologies including Data Capture & Digitization, Workflow & Robotics Process Automation (RPA), AI/ML based solutions, and Operational Analytics. Combining our extensive automation expertise and deep understanding of Health Plan systems like NASCO, FACETS, QNXT, we help you quickly identify opportunities to automate and achieve optimal business outcomes.
Our partnerships with leading automation platform providers combined with our proven implementation methodology helps optimize your automation investments using our accelerators and pre-built assets.
Our unique remote assessment and delivery approach allows you to cost effectively scale automation, a critical success-factor in the post-pandemic world.
We work closely with our clients to deliver strategic business outcomes while providing a differentiated commercial model that shares risks and guarantees benefits
Process mining, reengineering & digitization across functional areas
Design and Implementation services underpinned by Automation COE and Factory
End-to-end automation services, BOT analytics, exception management
Challenges: Open enrollment is an annual activity that requires Health Plans to scale significantly in order to meet customer requirements. The short enrollment timeframe results in numerous queries from customers, unclear requirements and results in insufficient enrollment document submission leading to poor customer experience, satisfaction and revenue for Health Plans.
Intelligent Automation technologies such as RPA, digital intake, digital agents and intelligent IVR can extract, validate, update and provide a seamless digital interaction experience to Health Plan customers during enrollment, and help deliver superior customer experience
Tangible benefits of Intelligent Automation:
20% to 30% reduction in cost of service
Higher flexibility and scalability to meet the ramp
Challenges: Health Plans invest significant effort and monies on processing claims that do not auto adjudicate. Due to disparate legacy systems and the complexity of the rules for processing claims, a number of claims have pends or edits that require manual intervention to move through the adjudication process. Intelligent Automation allows Health Plans improve compliance, elevate financial performance and enhance provider satisfaction by faster processing of claims.
Tangible benefits of Intelligent Automation:
2% to 3% increase in auto adjudication rates
$2MM to $3MM in annual savings