Select Health, a non-profit health insurance plan serves more than one million members in the U.S.’s Mountain West region. They, along with their parent company Intermountain Health, are committed to helping people live the healthiest lives possible. When a member visits an Intermountain Health provider, the provider sends a claim to Select Health for payment. However, employees often need to manually intervene because some claims contain inaccurate information. To expedite the progress of these claims and meet key deadlines, Select Health relies on SS&C | Blue Prism® Chorus BPM.

Challenge

Medical and dental providers send 12 million claims to Select Health each year. The data in each claim must be accurate to ensure it’s paid properly and on time. But often, claims are submitted with incorrect information like an old provider address or an inaccurate tax identification number. Each incorrect claim had to be manually resolved by employees using SS&C Blue Prism Chorus Business Process Management (BPM). At any given time, the provider operations team could have a backlog of 10,000 items in the queue waiting for resolution. To make matters more difficult, once an error was discovered the claim would sit in a queue to be worked on until the error was fixed and then the claim was manually sent back to be completed. Select Health has agreed to pay providers interest on any claims not resolved within 30 days of receipt. Thousands of inaccurate claims sat in queues for nearly 60 days, which added unnecessary costs to the claims’ payment process. Select Health needed a way to speed up inaccurate claim resolution.

Solution

Nearly 1,400 employees across Select Health, including the claims department, utilize Chorus to optimize their workflows. When the claims department discovered that batches of erroneous claims often contained the same error, they knew Chorus could help.

Chorus now checks and sorts inaccurate claims according to error type. A provider configuration analyst reviews only one claim from the batch, updates it, and adds relevant notations. Once Chorus has this information, the system works through the remaining claims in the batch, performing the same fixes and adding the same notations. Only one claim is processed by an employee, and the rest are auto-corrected and paid without human intervention. 

This new process has positively impacted the business. Erroneous claims are now fixed and processed in three days — down from 60 days and a 95% reduction in processing time. Since claims are no longer held for more than 30 days, Select Health isn’t required to pay interest to providers. Members are happy too. Because their claims are paid on time, they aren’t fielding calls from providers looking for payment. Select Health employees have been freed from the repetitive process of fixing the same error again and again, and they’re not facing a large backlog.

Select Health continues to grow and is expanding its offerings to surrounding states. Chorus will help them scale their claims process with confidence and ease and help them deliver premium customer service to new and old members.