Meeting the Metrics: Increasing Claims Processing Speed and Compliance
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).
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
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.
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