Case Study
Founded by a group of business, health care, and community leaders, Lateetud’s client is a state-licensed non-profit, tax-paying, private health insurance company, known to be an innovative leader in value-based care. Today, the company is standing strong; it’s rated among the nation’s best health plans for member satisfaction and quality and serves nearly three million members with their rock-solid commitment to the relentless pursuit of quality, affordable health care for individuals, families, and businesses with an unparalleled consumer experience.
The customer processes large volumes of claims, out of which a considerable percentage of these are suspended for multiple reasons. When a claim is suspended, the customer must manually review the information and determine if additional information is required to process the claim. Post review, the associate submits the Other Injury (OI) data. The COB information is returned and the associate checks for updates in the database reports. Once this is completed, the request is submitted, and the claim is processed.
Lateetud conducted process analysis to estimate that about 33,975 claims are suspended monthly resulting in overheads of time and man hours expenditure.
Lateetud developed a process solution to automate the review of suspended claims for the Coordination of Benefits (COB) for dental, local and InterPlan claims. The steps followed for automation are:
Through the automation process, the bot creates a data matching algorithm for patient names and carrier information. It also creates managed data tables that allow for rapid and continuous update of carrier information.
