Our website uses cookies to give you the most optimal experience online by: measuring our audience, understanding how our webpages are viewed and improving consequently the way our website works, providing you with relevant and personalized marketing content.
You have full control over what you want to activate. You can accept the cookies by clicking on the “Accept all cookies” button or customize your choices by selecting the cookies you want to activate. You can also decline all non-necessary cookies by clicking on the “Decline all cookies” button. Please find more information on our use of cookies and how to withdraw at any time your consent on our privacy policy.

Managing your cookies

Our website uses cookies. You have full control over what you want to activate. You can accept the cookies by clicking on the “Accept all cookies” button or customize your choices by selecting the cookies you want to activate. You can also decline all non-necessary cookies by clicking on the “Decline all cookies” button.

Necessary cookies

These are essential for the user navigation and allow to give access to certain functionalities such as secured zones accesses. Without these cookies, it won’t be possible to provide the service.
Matomo on premise

Marketing cookies

These cookies are used to deliver advertisements more relevant for you, limit the number of times you see an advertisement; help measure the effectiveness of the advertising campaign; and understand people’s behavior after they view an advertisement.
Adobe Privacy policy | Marketo Privacy Policy | MRP Privacy Policy | AccountInsight Privacy Policy | Triblio Privacy Policy

Social media cookies

These cookies are used to measure the effectiveness of social media campaigns.
LinkedIn Policy

Our website uses cookies to give you the most optimal experience online by: measuring our audience, understanding how our webpages are viewed and improving consequently the way our website works, providing you with relevant and personalized marketing content. You can also decline all non-necessary cookies by clicking on the “Decline all cookies” button. Please find more information on our use of cookies and how to withdraw at any time your consent on our privacy policy.

Skip to main content

Health insurer

Putting knowledge to work

Industry: Healthcare
Region: U.S.

Health insurer automates and standardizes processes to clear Medicare audit backlog and reduce costs by 60%.

bluedash

Process quality issues gave this major U.S. health insurer a major backlog of tedious manual audits, and threatened to render it noncompliant with Medicare requirements. Atos got the process back on track with an efficient and scalable Knowledge Process Outsourcing (KPO) solution, and reduced the cost per audit by more than 60%.

The challenge

bluedash

A leading U.S. healthcare payer was facing issues complying with Medicare audits for maximum out-of-pocket (MOOP) payments.

MOOP is the amount a Medicare member is required to pay during a calendar year. After this limit is reached, the insurer pays all additional medical expenses for the year.

Unfortunately, two of the insurer’s back-end healthcare and pharmacy claims systems were out of sync, preventing accurate accounting of each Medicare member’s out-of-pocket payments. This led to a two-year backlog of unaudited claims, no mechanism to prioritize them, and no scalability to keep up with a steady inflow of new claims.

Atos was engaged to quickly audit the backlog of Medicare transactions, examine the existing process and make recommendations to improve ongoing process efficiencies.

Download client story

The solution

bluedash

Atos identified three error-prone manual processes that were good candidates for automation, including:

  • Line-by-line comparison of every mismatch in the claims and pharmacy systems
  • A simple code to categorize every expense mismatch as either “deductible” or “out-of-pocket” in the claims system
  • Pre-loading pharmacy claims data that matches the claims system

Atos proposed these changes and the insurer’s team implemented them to increase the speed of the audits, reduce costs and boost productivity.

The ongoing work is being executed by a team of Atos associates in Pune working closely with the insurer’s staff in the U.S.

Business benefit

bluedash

By employing an offshore team to execute the work, the insurer reduced costs, increased scalability, and achieved greater staffing stability and predictability. Atos KPO services reduced the cost to complete each audit by more than 60%, and the offshore team is able to rapidly scale up or down to manage variations in volume.

The process improvements also saved $1.3 million in costs and accelerated claims audit resolution time by 40%-50%. Total productivity has jumped by 45%, and several long-term benefits have been realized, including:

  • Detailed process data capture, for use in trend analysis and quality control
  • Improved process documentation available in the insurer’s knowledge repository
  • Proactive resource forecasting based on past trends

Since the project transitioned to ongoing support, the insurer has engaged Atos to provide similar KPO services for several other government healthcare products and business lines.

Related resources

Look Out for Insurance

Shaping the future of insurance

Building new ecosystems, connecting generations

Video

Evidian IAM and SSO

Solutions to ensure that personal health data remains confidential in Sint Franciscus hospital.

Press Release

Atos supports a digital future for University College London Hospitals

Creating a digitally enabled organization that provides the highest-quality patient care, education and world-class research.

Related information

Atos Digital Workplace

Healthcare

Our experts

Ruud van der Loo

VP Global Healthcare market

More client stories

bluedash

UGAP: Leveraging the move to cloud

Intelligent networks and integrated service desk at Siemens Healthineers

Streamlining manufacturing business with cloud-SAP for Siemens

Accelerating WA health system digitalization

Digital workplace services in Solent NHS Trust

Scottish Water and Atos: Partnership in action

Next generation networking delivers connectivity on tap

Putting a bot army to work for healthcare

Interested in our solutions?