Healthcare Payer

Healthcare Payer

Claims Processing: Vast Efficiency and Cost Improvements

Customer Lifecycle Management
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Healthcare & Pharmaceuticals
PDF

 

For more than 40 years, this company has provided document management and financial transaction automation to its clients. It is now a global leader in business process outsourcing (BPO).

Challenge

The company’s customer, a Fortune 100 healthcare claims processing company, was experiencing inconsistencies in exceptions processing and charts recycling that had led to lagging service metrics and a decrease in service quality. 

The BPO firm approached Aptara in need of a partner with a proven track record managing healthcare regulatory compliance who could help them help their customer. 

They asked Aptara to:

  • Accurately process over 1 million Medicare claims per month 
  • Meet pre-defined service-level agreements (SLAs) within 18 weeks
  • Significantly decrease turnaround times

Solution

Aptara developed a cost-effective workflow solution that includes monitoring systems and tiered skill-level service provision.

Aptara hired employees for the processing center, got them up to speed via web-based training, and built an IT infrastructure. Real-time monitoring and reporting ensured that the staffing level could handle the volume of work successfully.

Results

The improved workflow saved money and increased shareholder value. In addition, Aptara:

  • Reduced turnaround times by 12-hours 
  • Exceeded SLA quality benchmarks
  • Reduced recycled claims significantly via real-time exceptions processing monitoring
  • Significant cost savings