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Case Studies
Improving Efficiencies for a Healthcare Payor
About the Client
A leading provider of healthcare, dental, pharmacy, group life, disability and long-term care benefits in the United States wanted Infosys to develop a cost effective IT solution that would enable it to cut costs and streamline operations. The Infosys solution saved the client millions of dollars by helping it to improve its efficiency.
Business Need
The client needed to develop a cost effective IT solution that would help cut costs and streamline operations. The company had a claims processing system, which adjudicated the claims received from members based on the company's business policies and rules. An online system was used for the claims processing, with special claims marked as pending if they required manual intervention. Infosys was called in to firm up all these operations.
Challenges and Requirements
The client handled a huge number of members and providers, so developing a robust system to meet all their needs was the biggest challenge. Apart from this:
- Since quick turn-around time was mandated, Infosys had to enhance development and runtime speed without sacrificing quality
- The existing infrastructure consisted of a mixture of legacy systems and state-of-the-art technologies. Infosys needed core competencies in both areas, which could ensure that the old and the new could seamlessly integrate and deliver maximum performance
- Extra functionality had to be added to process newer claims by generating them from within the system and this process too was expected to add substantially to the savings
- The claim checking module needed to be enhanced to incorporate new business logic. Historic claims, which had been pending in the system database for too long, also needed to be handled. These were expected to generate savings on a weekly basis
Infosys' Role
The Infosys Global Delivery Model was leveraged to save costs and the team consisted of 48 personnel. Initially, the existing system had to be carefully scrutinized and for this, the InFlux methodology was used to cut down on the time taken and also to generate a lot of intelligent data, which could be used by the team in subsequent stages.
Infosys prepared a System Appreciation Document, which highlighted the various tasks to be performed. The offshore team helped the onsite personnel with production support activities and streamlined operations. Problem logs that showed the specific nature of problems to be solved were generated and various modifications to the system, concerning major and minor enhancements, were drawn up and successfully implemented.
As part of the improvement process, the claim flow for re-pricing was automated, various enhancements were done under National Advantage Program (NAP) and new functionality was added. An automated system for adjusting historical claims was also developed, apart from improving the claim check module by introducing the re-bundling logic for claim detail lines. Infosys also worked on optimizing the solution for the logged problems.
Client Quote
"This was a sure victory for us with this customer as it shows we can meet their needs in a high quality manner. This is a classic example of what makes (client) the great company that it is."
Benefits
Specifically, the cost savings included:
- Once the claim check module was enhanced with new business logic and the historical claims automated, the client started saving between US$ 0.1 to US$ 0.5 million every week
- Yearly savings of US$ 1.125 million resulted from the new functionality added by Infosys
- Automating the claim flow resulted in annual savings of around US$ 2 million
- The National Advantage Program (NAP) project enhancements resulted in cost savings of around US$ 7 million annually
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