Challenge
US healthcare payers today are seeking to simplify their complex enrollment and case installation processes, in order to reduce the ‘Quote-to-Card’ cycle time, and minimize delayed and incorrect claims processing. However, their continued dependence on manual data entry and enrollment management processes, combined with the lack of integration between disparate silo-ed systems, is impeding operational efficiency. The furnishing of inaccurate, incomplete applications also leads to delayed onboarding, as it necessitates rectification and follow-ups with third-party administrators and other stakeholders.
TCS Solution
Salient components of the solution include:
- Data Integrator: Processes electronic data collected from multiple sources and ICR, and then scrubs, validates, and converts it into HIPAA 834 and other formats; segregates accurate records from incorrect ones; allows users to leverage self-service feature for log-in, file uploading, and error correction
- Intelligent Character Recognition (ICR): Reads data, with data entry associates validating it; updates data processed by an Artificial Intelligence Machine Learning (AI & ML) algorithm
- Robotic Process Automation (RPA): Updates the case installation screens; emails data-related errors to associates and tracks those via the workflow tool
Benefits
TCS’ Enrollment 360 Digitized Solution delivers the following benefits:
- Reduced Quote-to-Card cycle time: Ensure convenient and secure onboarding, and shorten the cycle time for issuing enorllment cards to between 5 and 7 days
- Higher operational efficiency: Reduce member enrollment costs by automating capture and loading of data; process huge data volumes smoothly; boost operational efficiency by as much as 45%
- Enhanced customer satisfaction: Increase workflow transparency by gaining end-to-end visibility from pre-enrollment through enrollment
