Claims Processing Program Needed a Checkup of its Own

Client Background

Worldwide Leader in Insurance and Financial Services processes over 3 million workers compensation bills annually!

Challenges and Requirements

The cost of doing business as well as the production headcount was growing on an annual basis. This company conducted a nationwide search for a business partner that would bring:

• Innovation
• Claims Processing Expertise
• BPO Best Practices and
• Proven track record for re-engineering internal processes that would deliver not only expense reduction but improve turnaround and product quality.

The MetaSource Solution

After a detailed vetting process and demonstration of thought leadership through operating best practices, MetaSource was selected to lead this profit and process improvement initiative. As the result of our process diligence and collaboration with the client, a multi-phase plan was developed to achieve the targeted business objectives:

Phase 1 - addressed processing bills for the state of California, beginning with MetaSource scanning and capturing HCFA, UB92, and non-standard medical bills. Within 24 hours of receipt, images and data were returned to the client. This component of the process introduced the ability for the client auditors to perform final bill review and resolution in an imaging environment.

Phase 2 - involved the client scanning bills at the hub locations and providing the images for processing. During this phase, our client implemented their own image retrieval and adjudication system. This system included the ability to track a document from the time of scanning to the processing of payment. The implementation of this reporting system has allowed for a significantly better monitoring of bills, including the ability to better plan for production and to address delays in processing that could lead to penalties and fines. This phase also included the roll out of all remaining national centers.

The Result

Through the introduction of our Claims Assurance Program, our Client was able to enjoy the following benefits:

• Create an overall saving from the initiative of over $10 million
• Reduce the average bill processing time to 15 hours
• Increase targeted daily productivity for bill processors by 50%.
• Decrease program headcount by over 150
• Removed overall quality concerns
• Significantly improved the ability to track and monitor the bills moving through the system

We Can Help

Contact MetaSource for more information on how we can help with your company's BPO and claims processing needs.