The Challenge: Inefficient mail operations led to poor member experience
The client is a leading US-based Health Plan with a workforce of over 285,000 professionals and a presence in more than 130 countries. As a diversified healthcare organization, the client aims to create a healthcare system that is connected, aligned and affordable for all stakeholders.
The volume of complex documents flooding the client’s mailroom was growing rapidly.
Inefficient mail center operations that require human operators to review thousands of keywords can make it hard for insurers to identify urgent documents. Each month, the client’s mailroom received a large volume of documents in both digital and physical formats. As a result, it took the client 12 hours to process faxed medical records and 24 hours to process appeals and grievances. This mattered enormously to patients waiting for treatment.
Optimizing mailroom and data capture operations was a top priority for the client and its provider customers. The client turned to Firstsource for an automated solution that would enable faster, prioritized turnaround of urgent documents while ensuring greater accuracy and reducing costs.
The solution: Harnessing digital mailroom and data capture processes
Firstsource leveraged their Digital Intake solution powered by AI/ML, Multi-OCR, RPA, Analytics, Reporting, Process Mining, and a rules-based high-performance workflow engine, supporting highly automated mailroom and data capture processes, corrections and quality audits. We optimized the client’s mailroom operations by leveraging:
- Optical Character Recognition (OCR) and Intelligent Character Recognition (ICR) technologies – an activity that now takes place in minutes instead of hours, enabling faster downstream processes
- A digital workflow splits, sorts, categorizes and indexes all documents for further processing
An intelligent machine learning solution identifies relevant keywords, keyword combinations, and keyword exceptions in order to segregate urgent documents quickly.
Once the system identifies an urgent appeal or grievance, it is pushed into a separate processing queue for priority processing. If the system is unsure whether a document is urgent or not, the document goes to human operators for exception handling.
The result: Quick turnaround times boosting member experience
By streamlining the Healthcare Claims Processing workflow, TAT for urgent appeals was lowered from 24 hours to 4 hours while TAT for faxed documents was reduced from 12 hours to half an hour. OCR/ ICR ensured claim documents were processed with 100% accuracy.
Today members’ claims are processed faster and are driving better patient experiences for the Health Provider.
