Automating Claims Management in a Value-based Healthcare System Helps Clients Achieve 65% Reduction in Claims Backlog
One of the fastest-growing children’s health organizations in the US trying to implement value-based care models.
AiRo worked with the health system’s payers and the client to create a uniform set of data input that could be used for automated claims filing regardless of the customized plan. The team then created an automated system to fetch the required data from various sources based on the requirements of the plan.
The shift from fee for service model to a value-based care model results in the plurality of plans available which in turn results in increasing complexity of automating the payment system owing to the increased customization.
The client saw an opportunity to address its difficulties with the required processing of a monthly data load that was error-prone, time-consuming, and costly and engaged AiRo to increase claims processing throughput using automation.
AiRo worked with the health system’s payers and the client to create a uniform set of data input that could be used for automated claims filing regardless of the customized plan. The team then created an automated system to fetch the required data from various sources based on the requirements of the plan. We implemented our Process Automation solution to process the low-to-medium complexity work that represents the bulk of claims received and tuned it to process many common edits. To address the issues with the file data load, our team helped clean the data and fine-tune automation processes to load the files and reduce the amount of human intervention required.
Reduction in claims backlog
Reduction in processing time
