At a glance
Industry
Healthcare
Challenge
Fast transition from legacy system to modern platform for complex claims
Products and Services
Cognizant Robotic Automation Services
Success Highlights
- 162% return on each dollar invested
- 10,000+ hours saved monthly
Our approach
Cognizant automation specialists coordinated with CareOregon process owners and subject matter experts to develop unique scripts to handle the complex data requirements of value-based behavioral health claims and provider contracts. We collaborated to identify and prioritize the most critical processes in the data migration and continuing workflows. Aligning member and provider data and incorporating new claims processing steps in QNXT topped the list. These tasks had to be accomplished swiftly and accurately to avoid business interruption.
We developed nine robots for the following specific tasks and processes:
Provider data:
Six robots were created to add and update participating and non-participating providers, contracts, demographic information, affiliations and attributes as part of the behavioral health claims migration to QNXT. The bots processed almost 13,000 records, saving more than 430 hours of manual processing time.
Eligibility load:
We automated the one-time mass migration of member record information, with one robot processing over 15,000 records, saving more than 500 hours of manual processing time.
Behavioral health claims processing:
Introducing new behavioral health-related authorizations and claims pricing on the QNXT platform prompted the creation of a case rate robot and an authorization matching robot to automate processing and pricing on these claims. On average, the two robots process 15,000 work items each month. In the first six months of production, the two robots saved an average of 485 hours per month of manual processing time for CareOregon.
Ongoing process automation:
The new behavioral health robots complement CareOregon’s existing substantial automation footprint, which includes more than 10 other robots which handle such processes as coordination of benefits, manual pricing, timely filings, corrected claims and more. Over a six-month period, Cognizant robots processed a monthly average of 96,000 work items in addition to the behavioral health items.
Business outcomes
The software robots free up human resources by reducing hours of manual labor and working quickly and accurately, with limited need for human intervention. This allows CareOregon claim examiners to focus on other critical tasks, such as managing complex claims and quality audits. In addition, the robots serve as effective interim solutions until technology changes can be implemented. The results are quantifiable, and our client’s ROI continues to increase:
Behavioral health migration:
- 930 hours saved for member and provider data alignment during migration
- 485 hours saved monthly with new case rate and behavioral health authorization matching robots
Existing robotic automation:
- Averaging over 10,000 hours saved monthly across 10+ QXNT automations
Realized ROI:
- For every dollar spent, $2.62 is saved in cost of hours worked (162% return on each dollar invested)
