A leading US healthcare payer enhanced its provider outreach with 18.4% improvement in letter accuracy and 20% decrease in turnaround time in sending letters, leading to savings of USD 254K
Client Background
The client is one of the largest healthcare payers catering to about 68 million individuals in the United States. Ranked among the top Fortune 500 US companies, it offers a broad spectrum of products and services.
Industry Landscape
The total US healthcare expenditure is expected to soar to $3.78 trillion by 2018. The industry incurs additional cost due to inaccurately processed claims, which in turn affects the overall cost of healthcare policies. The need of the hour is to reduce the additional cost incurred by healthcare companies because of increased re-work, interest expense and overall turnaround time.
Opportunity
It was crucial for the client to provide flawless information to healthcare providers describing the decision taken on claim adjustments and indicating the need for any additional information. This was carried out through letters, which did not follow any standard format and contained free form text. As a result, provider comprehension was significantly affected and led to clarification calls to the customer service team, which increased the call volume and provider dissatisfaction. The major challenge was inconsistency in responses across the claims process due to manual intervention for drafting letters, which was further affected by selection of wrong letter formats and interpretation issues.
Solution
Wipro changed the client’s traditional way of communicating with providers with advanced process restructuring and automation. Wipro had been partnering with the client to help manage its shared services domain in IT and back office operations.
Solution highlights:
Business Impact
Deployment of effective solutions resulted in flawless execution of provider outreach practice, leading to reduction in error and re-work. Also, a standard communication procedure was established.