Case Study: Insurance
Delivering innovation and $20 million in annual savings for casualty third-party administrator
Registered nurses, proactive process reengineering, and proprietary tools combine to meet changing consumer and corporate needs
Our breakthrough success with this client started with only 10 FTEs handling one of their service center clients. Based on our in-depth workers’ compensation experience with a sizable client portfolio, Sagility immediately identified approximately 12.5% of the total bills were inaccurately coded which resulted in higher payout. We took on the challenge to understand coding patterns across various specialties and potential overpayments/ opportunities for improved payment accuracy. We deployed a payment accuracy tool, tailored to the client, to filter and extract sample bills.
Sagility reengineered strategy to show the client the value we could bring with our RNs and CPC-certified coders reviewing medical records, patient history, and severity to determine appropriate coding. Our strategy is a structured approach to determine factors of value, apply change management feasibility, and work through a technology feasibility lens.
The client has since counted on Sagility for a widening scope of services, including re-evaluations; complex nurse review for medical necessity, compensability, relatedness/appropriateness; and code review by certified professional coders. Today, Sagility is successfully handling more than 30 independent clients on the client’s platform supporting end-to-end medical bill review services.
Throughout our partnership, Sagility has demonstrated value that transcends our initial role as a transaction partner. We have provided crucial support to this client’s savings objectives while also co-creating solutions and innovation to support larger business goals.
$20msaved in a year
$70msavings over 4 years
In addition, Sagility has brought proprietary tools such as our Inventory Management Tool to proactively manage inventory within state stipulated timeframes to avoid interest and penalty due to delays. Today Sagility’s consultative, proactive strategy works across siloes to also enhance profitability, provider relations and enable billing and coding, which are all key to transformation for this client partner.
The client has been so confident in Sagility’s consultative approach that they have trusted us with another casualty line of business on the auto side. We have started providing the people, process, and technology to pave the way for even more value creation. Additionally, we have taken on provider calls and provider negotiations, as another area of significant opportunity for CSAT and TAT enhancement.