Solution: Intelligent automation
Spinning its wheels
A major US-based healthcare provider was making approximately 4,000 phone calls per day to verify Medicare eligibility for claims processing. Fewer than 10 percent of the calls required human interaction or decision making.
In addition, the company had to frequently make manual calls to the Centers for Medicare & Medicaid Services (CMS), which increased both its employee workload and the operational costs.
For it to optimize its time and resources, the healthcare provider needed to reduce manual work, avoid unnecessary phone calls and eliminate repetitive tasks.
Truly intelligent automation
Partnering with Atos, the healthcare provider accelerated and streamlined its day-to-day business processes — and gained differentiating intelligence.
To validate a patient’s Medicare eligibility, the bot uses RingCentral to call an 800-number and interact with the CMS IVR system. It captures the voice response and uses a voice-to-text AI/ML module to extract the patient’s Medicare status and update the back-end system.
In 90 percent of the cases, the patient does not have Medicare eligibility, and no further action is needed. For the other 10 percent, the bot routes the cases to a human agent in order to proceed with the next steps.
Atos’s process automation solution mimics humans’ repetitive, rules-based, structured data activities to reduce costs, improve Medicare eligibility validation and free up talent.
By combining machine learning with natural language processing and robotics, the solution enables healthcare providers to automatically initiate calls, identify service requests from members and verify Medicare eligibility for submitting claims.
Spending time on what matters
The healthcare provider successfully automated these mundane and repetitive tasks, freeing up the time of eight full-time employees to concentrate on serving patients better.
The company’s previous record for call handling was 800 per day. Now it can validate and process information from more than 4,000 calls per day without manual intervention.
When claims volumes are high, as they were during the pandemic, the system improves customer service by finding answers quickly; routing calls to human agents only when needed.