Healthcare Provider

Healthcare Provider

Meeting the Metrics: Increasing Claims Processing Speed and Compliance

Customer Lifecycle Management
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Healthcare & Pharmaceuticals
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For more than 40 years, this company has provided document management and financial transaction automation to its clients. It is now a global leader in business process outsourcing (BPO).

Challenge

The company’s customer, a Fortune 100 healthcare claims processing company, was not meeting its metrics for 24-hour end-to-end query resolution, and manual processes were inflating per-transaction costs. In addition, claims recycling issues were slowing down its service provision. 

The BPO firm approached Aptara in need of a partner who could help them help their customer. They required:

  • Demonstrated expertise in indexing, data capture, query resolution, and regulatory compliance specific to the healthcare industry
  • Resolution of up to 50,000 claims and 20,000 queries per day with 99.6% accuracy
  • Meeting an abbreviated 2-month transition and ramp-up requirement
  • Hitting service-level agreements (SLAs) within those two months

Solution

Aptara designed and implemented new streamlined processes. In addition, they moved swiftly to recruit a dedicated team, train the staff using a web-based curriculum, and build out a supporting IT infrastructure. Real-time monitoring ensured staffing levels could manage the transaction volumes successfully. 

By combining highly skilled personnel with user-friendly technology, Aptara achieved 24-hour turnaround times -- from day one.

Result

In addition to meeting the turnaround targets, the teams:

  • Met quality target metrics by week 2, and subsequently exceeded them at 99.9%
  • Surpassed query resolution (DDC) TATs (0.5 DROH to 0.6 SLA)
  • Decreased keystrokes per claim from 185 to 85
  • Reduced per-transaction costs