Client: One of the largest integrated health care delivery and financing systems in America.
Challenge: Create a new claims system to bypass cost-sharing codes for COVID-related procedures.
Solution: Three bots that automated processing of COVID-related claims
Results: Processed 318,000 claims in two months, brought quick relief to members in a time of intense need.
When COVID-19 plunged the world into chaos and confusion, Lumevity’s client fought for the health and well-being of its members. In the face of widespread economic instability, fear, and a global medical emergency, the integrated health care company waived out-of-pocket expenses for all COVID-related procedures. From biweekly COVID tests to telehealth visits, the client gave its members the financial stability and peace of mind to successfully navigate the uncertain waters of the early pandemic.
While this new policy brought significant relief to members, it quickly became clear that to accommodate the waived expenses the client needed to develop a unique, COVID-specific system for processing and approving claims.
But building, learning, and implementing a completely new system would drain the claims team’s time and labor – two resources that, due to the global pandemic, they simply couldn’t afford to waste.
With thousands of COVID claims on the horizon and an overwhelmed processing system, the claims team needed a way to efficiently process claims and quickly deliver benefits to members.
After working with the client to understand the claims system, the Lumevity team developed three automation solutions that specifically bypassed the normal cost shares for procedure codes. Developed and operationalized over just three days, these bots allowed the client to funnel COVID-related claims through specific and exclusive channels.
These automation solutions improved the claims approval system for all stakeholders involved: payer, providers, and patients.
With faster processing times and lower margins of error, the automated applications saved the client time and protected the company from negative financial impacts, such as high labor overtime costs or performance guarantee penalties.
In turn, the expedited claims process allowed the client to pay providers promptly for their services and fulfill professional obligations in a timely manner – even in the midst of a pandemic.
Finally, automation solutions brought quick financial relief and significant peace of mind to all members. Without having to worry about paying for medical procedures, patients could simply focus on keeping themselves and their loved ones safe.
This collaboration between Lumevity and the client’s claims team highlights the power of pioneering technological innovation with a human-centered design lens. As independent pieces of automated technology, the solutions are certainly impressive. But they truly brought value to the client because they responded to a deeply human need: the quick and accurate processing of COVID claims. Efficient, repeatable, and finely tuned to the human experience, the solutions’ hard technology optimized the client’s established claims process and brought financial and psychological relief to millions of members nationwide.
Three new bots expedited COVID-19 claims processing.
318K claims processed
In just two months of use, the bots processed a total of 318,000 claims, bringing quick relief to members – and prompt payment to providers – in a time of intense need.
With 10,000-12,000 new claims submitted daily, the repeatable and dependably accurate bots continue to play an essential role in the client’s ongoing COVID-19 response.