Healthcare Agency Automates Claims Submission and Inquiry Processes for Powerful Efficiencies

Healthcare agency automates claims submission and inquiry processes with Emtec 60% of 1.1 million annual claim inquiries now electronically fulfilled with automated query response.
Healthcare Agency Automates Claims Submission

and Inquiry Processes for Powerful Efficiencies

Challenge

As part of a multi-year strategy of digital enablement and transformation, this provincial healthcare agency looked to modernize their claims and inquiry processes to reduce tedious and manual processes required of their medical service providers so they can spend more time focusing on patient care. Their current processes had multiple challenges including:

    • A highly manual new doctor registration and licensing process despite the use of scanned application forms
    • Medical claims inquiries were tedious requiring many duplicate data requests, placing a significant burden on medical providers
    • As a single payer health system with thousands of claims submissions each week, their arduous claims submission process led to severe bottlenecks
    • Multiple request processing platforms made tracking inquiries across the agency difficult
Their goal was to drive to an automated, single-claim submission model for agency-wide efficiencies and they looked to Emtec to make it a reality.

Solution

Emtec replaced an aging, customized environment with a BMC Remedy based, automated, multi-faceted solution for 8 service centers which support 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 1500 claim requests per day are now processed through its eSubmit digital claims processing and license management platform
  • 60% of 1.1 million annual claim inquiries now electronically fulfilled via the IMS platform with automated query response made possible by integrations to all customer service groups
  • 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 in place, the client is now poised to expand current functionality with the adoption of natural language interaction (NLI) as well as elevate engagement with proactive communications based on intelligent analysis of their systems of record (aging payables/receivables, outstanding training updates, unused subsidies etc.) across all service centers.

Industry
Healthcare, Government

Revenue
$488 M

Headquarters
Canada

Employees
4000

Business Impacts

      • Over 50% reduction in time spent reviewing claims by senior agency resources
      • 60% of 1.1 million annual claim inquiries are now electronically fulfilled with automated query response
      • Over 1500 claim requests now processed per day

Contact our team today to digitally enable and automate your manual processes.