Case Study: Healthcare
Deploying smart automation to re-engineer leading payer’s collections, enrollment, and eligibility
Costs, turnaround times, and manual errors significantly decreased through digital solutions
Sagility provides a broad array of claims management and member lifecycle services for this client, including international claims service to process healthcare claims filed abroad by client members. This site processes claims from 90 countries. Sagility has supported a key client objective of a turnaround time service level expectation of processing 98% of claims in 10 days. To ensure this success, Sagility deploys expertise at every stage of the lifecycle. Sagility works with the client’s premium collection and eligibility platform. This claims adjudication system and client/server application is used for the client’s end-to-end operations.
We use this application for all the following functional attributes toward claims adjudication:
Sagility’s team continues to build on the expanding portfolio of solutions built for the client, with intelligent automation and analytics solutions identified for the client’s premium collections, member enrollment, and eligibility groups.
Sagility developed a solution with process re-engineering to maximize outcomes for 70% process automation, for a potential savings of $650,000. The bot conducts premium cash posting of appropriate remittances received, as well as posting of fallouts, 5500 tax processing, and premium reconciliation.
Sagility is currently testing for this 50% automated process solution, with a potential savings of $500,000. The Sagility bot automates enrollment for new members with bulk form submission.
Sagility is currently designing a solution targeting an automation outcome 50% or higher, for potential savings of $500,000. This automation increases efficiency for the automated eligibility and benefits administration process, including focus areas of enrollment, termination, reinstatement, additions, and changes.
Additionally, Sagility’s bot creates a reporting dashboard to track incoming cash, postings, and fallouts on eligibilities, with extensive enrollments tracking. This is a value-added consultative service, as the client uses these insights today to ensure operational efficiencies and refocus their financial forecast.
With all three processes in various states of launch, Sagility estimates up to 50% cost reduction in EDI member enrollment and member eligibility and up to 50% cost reduction in premium collections. Additional benefits will include decreased turnaround time and decreased manual error. We have already delivered labor savings of approximately 60%, reducing staff from 25 to 10 team members. Additionally, we have significantly reduced TAT from 3.5 days to only three hours, a 96% reduction.
Cost reduction in member enrollment premium payment and member eligibility:
Cost reduction in electronic data interchange (EDI), manual eligibility
Smart automation innovation:
96% reduction in TAT