Driven by our positive experiences with the best online stores, we are now demanding the same ease of use and excellent customer service from every company we do business with.
The health insurance industry has not been immune to this pressure. In response, health insurers have made it much easier to sign up for their insurance products. Gone are the old days of filling out and mailing stacks of paperwork and waiting weeks for approval. They hired digital transformation experts with expertise at creating a positive customer experience and the new websites are much better. The paperwork can now be done online and in most cases, enrollment can start within a few days.
This is good for everyone. The consumer doesn’t have to wait as long to see a healthcare provider. The insurance company receives the premium revenue faster.
So far, so good. But no one buys health insurance just for the thrill of owning a new medical card, or for the stress of undergoing medical treatment.
The true value of health insurance comes when it is time to pay the bills. This is known as the claims process. And this is where many health insurers fall far short of delivering a good customer experience to their subscribers.
Slow Pay or No Pay
Delayed or inaccurate claims processing directly impacts the customer experience. This can result in a loss of revenue if disgruntled customers decide to switch insurers as soon as they are able. In the United States, most people receive their health insurance through a company-sponsored plan backed by a health insurer. If there are too many complaints about poor claims service, the company will soon switch to another insurer taking hundreds or even thousands of customers with them.
When an insurer is slow to pay for your medical treatment, we know what happens next. You are hassled by the Accounts Receivable department at every healthcare provider involved with your care. Your mailbox and inbox fill with past due statements designed to frighten and confuse the average consumer. Then come the threatening collection phone calls. This is incredibly stressful for any sick person and their family members. In the age of lightning-fast enrollment, when the insurers are quick to collect our premiums, claims payment has lagged far behind. We are more than justified to demand better claims payment service.
In the age of lightning-fast enrollment, when the insurers are quick to collect our premiums, claims payment has lagged far behind.
Health insurers are aware of the importance of automation in claims processing. According to the World Insurance Report 2018, 48% of health insurers claimed they use robotic process automation (RPA) to streamline the claims process.
So why is there still a problem?
Hard to Pay
RPA alone isn’t enough. Claims payment is a complex document-driven process and is only partially digitized, meaning there are still a substantial number of claims submitted as paper via mail, scanned images, faxes or a PDF form attached to an email. The documents come from a variety of healthcare provider billing systems, and there is no single standard document template. Human intervention is necessary to convert this information into the insurer’s claims payment system.
As we know all too well from similar document-driven processes, this often leads to mistakes, especially when transferring information from the submitted documents. If even one letter or number is incorrectly entered, a claim payment can be rejected. Relative to automated processing, humans are also slow workers and hold up prompt payment.
Automate to Pay Faster
Insurers can dramatically improve the time-to-payment for claims by implementing a Straight Through Processing (STP) system powered by intelligent document processing software.
The ability to complete a task without the need for manual intervention is often referred to as straight through processing. Tasks can move “straight though” in a fully automated manner. This capability relies upon a very important factor: the ability to determine with high precision that a task was not just executed, but that it was executed correctly.
The process of achieving STP on complex document-oriented processes is not as straightforward as simpler tasks. This complexity has resulted in some organizations using advanced capture solutions to automate tasks, only to find that they need to verify every single result. The upside is that while the answers to achieving STP are not as straightforward as what you can expect with simpler tasks, it is possible. It just requires a different approach: one based upon data science.
All About the Data Science
Unlike rules-based task automation, automation of document-oriented tasks involves more sophisticated technologies including computer vision, classifier algorithms and pattern-matching. While no technology can deliver 100% certainty, a well-designed system can achieve predictability and dramatically lower the need for human intervention.
System predictability is based on the careful curation of sample data, which is representative of the larger population of production data. Using that set, the data is analyzed to arrive at the right mix of algorithms used to create a specific task configuration. The results of the configuration are then analyzed against expected output to identify the “signature” of accurate data.
From there, the system is then able to determine, at accuracy levels that reach 99% correct data from incorrect data. All of this means that complex cognitive tasks such as claims processing can benefit from straight through processing. The benefits will include significantly faster time-to-pay for customers and reduced operational costs for the insurer.
Deploying Straight Through Processing
In order to truly improve claims payment and delight their subscribers, health insurers need to deploy as much straight through processing as possible. This is their best tool for closing the yawning gap in customer satisfaction that currently runs between enrollment and claims processing. If you are unsure where to start, contact an expert to begin the conversation.
About the Author
Dan Lucarini is an AIIM Fellow with over 25 years’ experience in capture and content management technologies. Learn more at www.linkedin.com/in/danlucarini.