Challenge / Goal
As part of a multiyear strategy of digital enablement and transformation, a provincial healthcare agency looked to modernize their claims and inquiry processes to reduce tedious and manual processes and devote more time to patient care.
Their goal was to drive to an automated single-claim submission model for agency-wide efficiencies. As a single-payer health system with thousands of claims submissions each week, the agency’s current processes had multiple challenges including:
- A highly manual new doctor registration and licensing process, despite the use of scanned application forms
- Tedious medical claims inquiries that required many duplicate data requests, placing a significant burden on medical providers
- An arduous claims submission process that led to severe bottlenecks
- Multiple request processing platforms that made tracking inquiries across the agency difficult
Seeking an experienced partner, they turned to Bridgenext (formerly Emtec) to achieve impactful improvements.
Solution
Our team replaced an aging customized environment with an automated, multifaceted BMC Remedy-based solution for eight service centers. Supporting both medical care and residential care facilities and their medical practitioners, the solution features:
- Modernized electronic eSubmit and Inquiry Management Systems (IMS) for claim submission and inquiries about status of licensing, claims or other applications
- Platform integrations with employee portal, document management and digitally enabled requestor communications as well as other enterprise applications
- Workflows and process automation for enhanced forms processing to manage licensing and onboarding of new/changed providers
Results
- Over 1,500 claim requests per day are now processed through the eSubmit digital claims processing and license management platform.
- 60% of 1.1 million annual claim inquiries are now electronically fulfilled via the IMS platform with automated query response made possible by integrations to all customer service groups.
- The new comprehensive workflow solution seamlessly manages licensing and onboarding of new or changed providers with full dashboard-based application status monitoring and escalation based on SLOs.
With new digitally enhanced processes and platforms, the client is now poised to expand current functionality with the adoption of natural language interaction (NLI). They’re also able to elevate engagement with proactive communications based on intelligent analysis of their systems of record (e.g., aging payables/receivables, outstanding training updates, unused subsidies) across all service centers.