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| Case Study |
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Patni's Health Claims Conversion capabilities levels to a new high
helps client raise accuracy and productivity levels to a new high |
A large provider of Health Insurance services increases accuracy and productivity levels along
with a significant reduction in the time taken for processing claims, as Patni reengineers and
optimizes its processes using Six Sigma practices and an offshore approach.
The Client
The client is one of the largest providers of insurance for students, individuals and selfemployed people in the
US.
The Challenge
The Client had outsourced the process of converting paper claims (HCFA
1500 & UB 92) to a service provider, who was not meeting the required
service level agreements (SLAs). Some of the challenges faced by the
client included:US.
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Streamlining the process to reduce the amount of re-work and
number of errors caused due to ineffectiveness in meeting the SLAs by the service provider |
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Increasing accuracy and productivity levels to remove a huge
backlog of claims in a short timeframe. |
The Solution
The client identified Patni as the new service provider to help the company smoothly
transition the entire process, initiate operations, maintain accuracy and productivity
standards. After a complete process study, Patni's process consultants mapped the current
process and re-engineered the process architecture for delivering the services from offshore.
The process transition exercise was completed within 2 weeks, well within the target date.
Patni developed the workflow for picking up the images and the EDI converter for generating
the HIPAA Compliant ANSI 837 EDI output. Subsequently, in the pilot phase, Patni began to
provide data entry of HCFA & UB claims from its offshore BPO facility at Noida, India. Patni is
currently handling all HCFA 1500 and UB 92 claims for the client.
Once the pilot phase was satisfactorily completed, a "time and motion" study was conducted
for "baseline analysis" for measuring productivity. This was done to reduce the defects in the
process by a minimum of 50%, which in turn would increase the accuracy levels to more than
99%.
A brief overview of the process:
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The client sends images of the HCFA & UB claims in .tif format through its secured FTP |
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Patni downloads the images at the offshore BPO location at Noida |
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All the images are uploaded onto the workflow for enabling the associates to process
the claims |
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Each associate picks up the image from the workflow and completes the data entry of
each form based on the keying conventions and specifications provided by the client
and Standard Operating Procedures |
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After data entry of the claims, the output goes through the Quality Assurance cycle
where the QA associate checks the data for all the fields in the forms |
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A second round of quality check with 10% random sampling is conducted to eliminate
any possible error |
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The final output goes through the EDI converter to convert the output to ANSI 837
output. This output is uploaded on the client's secured FTP |
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A comprehensive reporting structure is adopted based on the client's requirements.
Additionally, Patni has an internal reporting structure that facilitates the processor's
performance management based on his accuracy, productivity and turnaround time. |
Achievements
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Completed the transition and pilot phase in a short time frame
of two weeks and two months respectively |
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Productivity improved from processing 8 claims per hour
during the pilot phase to more than 25 claims per hour
through focused training and process innovation |
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Consistently achieved a 24 hour turnaround time in processing
claims |
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Right from the pilot phase, Patni has helped the client achieve
more than 99.5% accuracy through a strong focus on Six Sigma
methodology |
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Helped the client clear a huge backlog of claims. |
The Benefits
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Significant cost reduction, system stabilization and process
optimization; targeting and adhering to stringent service levels.
Accuracy levels are higher than the target level, averaging around
99.5% for the last three months, which is significantly higher than
the 99% fixed in the SLA. |
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Increase in efficiency and effectiveness of client's service delivery
mechanism, through significant increase in productivity, accuracy
and turnaround time. For example, the client can currently handle
huge variations in volumes without impacting the service levels |
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Exchange of best practices, and deep mutual confidence resulting
in the creation of a highly competent and optimized work force. |
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