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Workflow Wonders with ClaimCare Inc.

For almost two years we’ve been featuring inspiring success stories from Nintex customers around the world on our webinar series Workflow Wonders. Contrary to the name, Workflow Wonders features customers using any combination of Nintex capabilities to improve the way people work.

On our latest episode of Workflow Wonders, Carl Mays and Tony Villarreal from ClaimCare joined me to share how they leveraged Nintex RPA to support a spike in business at the onset of the pandemic, and how the tool continues to play an important role in their automation strategy.

Based in Texas, ClaimCare is a revenue cycle billing company that has been in business for more than 30 years. ClaimCare provides medical billing services to office-based medical specialties, labs, and freestanding facilities in more than 26 states. The company provides services on its clients’ systems, including AdvancedMD medical office software.

Navigating COVID-19

In March 2020 ClaimCare was already accustomed to working remotely as it moved its workforce remote four years prior. The company began exploring the use of automation in 2012 and knew there was much more they could do to automate and modernize processes.

ClaimCare quickly saw an unprecedented spike in business at the start of the pandemic from COVID-19 testing labs and organizations. They signed up several COVID-19 testing companies that had never billed insurance before and were unfamiliar with the data requirements. The clients also had proprietary front-end systems that would be used for gathering data and then had to be adapted to the extra requirements for medical billing data. Due to the nature of the pandemic, payer and government rules were also frequently changing.

“The result of this confluence of events was that we started receiving large volumes of extremely poor data while simultaneously dealing with payer billing rules that were in flux,” says ClaimCare CEO and President Carl Mays.

Carl and ClaimCare’s automation manager Tony Villarreal quickly resumed their search for a strong automation platform – and they landed on Nintex RPA.

Implementing Nintex

Once Nintex RPA was selected, Tony worked with the Nintex Professional Services team to implement a solution. The company set up what they dubbed a “war room” with 27 bots to automate manual processes and address the data issues they faced. The solution allowed ClaimCare to quickly deploy the equivalent of more than 100 employees without the need for training or time to ramp up.

“As a result we saw a 608% increase in claim volumes with a 427% increase in error rates,” shares Carl. “Thanks to the solution, we were able to process and address all the issues with only 65% increase in staff.”

Lessons learned

Since first implementing the solution to now, Tony and the team at ClaimCare have made significant improvements to their Nintex RPA solutions as they’ve learned more. Tony shares that the company’s journey was a high-tech version of learning to run.

They started by figuring out how Nintex RPA works – partnering with the Nintex Professional Services team and diving into the online training Nintex offers. They also realized the importance of domain expertise for successful automation. Next, they deployed the tool on simple processes – initial automation that moves the needle and using that experience to gain deeper expertise. Fast forward to now, and they are realizing how much can be done with automation and identifying new opportunities for automation.

Tony also shared a few key features ClaimCare now looks for in early automation efforts using RPA:

  • Redundant processes
  • No decision-making required
  • Significant volume and frequency to help show meaningful ROI
  • The need to move between few screens within the billing software
  • Easily replicable reports

Carl and Tony are continuing to look for new ways to leverage Nintex RPA across ClaimCare’s operations – and to improve the solutions they already have in place. Watch the webinar on-demand to learn more about ClaimCare’s RPA success with Nintex.



If you’d like to learn more about workflow and automation, get in touch with the team at Nintex today. Or if you’d like to test-drive the Nintex Platform free for 30 days, start a free trial.



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