Healthcare / Insurance Success Stories
United HealthCare - Expert System for Claims Review
The Challenge:
United Healthcare is a health insurance giant with revenues of about $9 Billion in the last several years. The company has grown rapidly over the last 15 years as the result of an aggressive acquisition program. Controlling costs and streamlining processes is vital to United HealthCare's continued success.
The Template Software Solution:
In-house software developers at United Health Care used Template Software products to build AdjudiPro - a client-server expert system that processes over half of the company's claims reviews. This system saved more than $13 million in processing costs in the third year of its use. AdjudiPro also supports United HealthCare's aggressive acquisition strategy by applying consistent claims review policies across disparate claims processing systems of the acquired companies.
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University of Michigan - Health Center Patient History and Billing
The Challenge:
Handling nearly 1.5 million patient visits annually, the University of Michigan's Health Services (UMHS) wanted to improve effectiveness and efficiency of patient records and billing information processing in the University's Patient Business Services. The volume of patients the University Health System sees annually required a sophisticated technology solution. Capturing required demographic or insurance information before the patient arrives and routing any suspect data to the correct team for validation, not only improves patient satisfaction, but also adds to the hospital's bottom line by reducing rejections and downstream re-work.
The Template Software Solution:
Based on its ability to support complex automation problems at an enterprise level and integrate information from a variety of existing legacy systems, Template Software was chosen to implement a three-phased business-critical solution for the University's Patient Business Services. Ultimately supporting 300-400 users, the Patient Business Services system is an automated business process management solution that proactively identifies critical data such as the insurance agent, insurance plan, and coverage details that might be missing from patients' records. The system improves customer service by streamlining administrative processes and improving UMHS' receivables to the University of Michigan.
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