Nintex LogoNintex

Home|Using Nintex|Case Studies|Claims repricer cuts medical processing time by 67%

Claims repricer cuts medical processing time by 67%

In the past, processing health care claims was a laborious, time-consuming task. A mid-sized medical claims service provider tasked OpenGate Consulting with the daunting challenge of increasing medical claims throughout and reducing time and effort to enter and reconcile claims—while maintaining rigorous security and accuracy according to industry benchmarks. With Skuid, OpenGate was able to deliver 100% of service provider’s requirements in less than five months. As a result of exceeding the provider’s requirements with Skuid, the company now estimates the average time for handling a medical claim has dropped from 15 minutes to less than five minutes—a 67% decrease.

Read more about their success below

Company
OpenGate Consulting
Website
opengate.com
Industry
IT
Capabilities Used
Application Development

OpenGate Consulting is a consulting firm that specializes in providing innovative solutions to complex business challenges, including those in the healthcare sector. They are tasked with increasing medical claims throughput and reducing the time and effort needed to enter and reconcile these claims, while ensuring high standards of security and accuracy.

The healthcare service provider needed a solution to drastically reduce the time-consuming and error-prone process of manual data entry for medical claims, which was not only laborious but also resulted in a high rate of inaccuracies and additional costs in reconciling these errors.

OpenGate leveraged Skuid, a drag-and-drop user experience platform, to develop a medical claims app that simplified the data entry process. By doing so, they managed to fulfill 100% of the service provider's requirements within five months.

Challenge

One of healthcare’s most time-consuming and confusing log jams is the process of reviewing patient medical histories and manually entering facility claim information. Reconciling payments to many providers from among multiple individual claims has historically been extremely complex and difficult, requiring massive amounts of time.

When a medical health claims service provider tasked OpenGate Consulting to solve these and other problems, OpenGate discovered that data-entry personnel spent more time manually entering pages of procedure codes than pricing customer medical claims. Specifically, the estimated average time for handling a single claim was 15 minutes. Entering a claim could take up to eight hours. The process was so complicated and error-prone that it required multiple reviews to ensure accuracy. Not only was this frustrating for all concerned, it cost the service provider even more research and claim reconciliation time to correct the inaccuracies.

Due to the immense complexity of the customer’s processes, after spending a year in development using .Net, the original development effort only resulted in a delivery of 20% of the customer‘s requirements. At that point, the client looked to OpenGate to not only get a new solution up and running, but also to provide a platform for growth.

Solutions

By leveraging Skuid’s drag-and-drop user experience platform, OpenGate created a medical claims app that significantly simplified medical claims data entry processes for the health care service provider’s employees. Within just five months, OpenGate delivered 100% of their client’s requirements. In fact, Skuid was so easy to use that OpenGate could actually build side-by-side with the customer’s business users, in realtime, as they were learning their complex business process. Iterations could occur in hours or days instead of weeks and months. OpenGate implemented change requests immediately, without the hassle of unit test code or lengthy deployment cycles.

Results

The new bespoke application has eliminated time-consuming steps, automating processes to maximize claims accuracy. Using Skuid, OpenGate estimates that the average time for handling a medical claim has decreased by 67%, dropping from 15 minutes, on average, to less than five minutes. In addition, according to Alec Elmore of CEO of OpenGate Consulting, “Using Skuid, batch medical claim entry has been reduced from eight hours to literally seconds.” This increase in productivity has allowed the service provider to enhance its value-added activities for its customers.

To date, OpenGate‘s customer estimates it has effectively doubled the output of the medical claims team with Skuid. The new app fully aligns the user interface around critical business processes in a way that reduces errors and ensures compliance with policies. Even better, users love the app because it is much easier and pleasant to use, and saves them massive amounts of time.

As an added benefit, the customer has spent relatively little time training employees to use the new claims processing app, because it is so user friendly. Says Elmore, “Skuid has fundamentally reduced our effort in training. When users look at a Skuid screen, they get it. It’s intuitive.”

Working with Skuid has fundamentally reduced our effort in training, and when users look at a Skuid screen, they get it. It’s intuitive.
Alec Elmore, Chief Executive Officer, OpenGate Consulting
Related success stories
AFL builds custom CPQ using Skuid, saves $1 million
In an innovative approach to tackling the challenges of their intricate configure, price, quote (CPQ) processes, AFL, a global leader in improving fiber optic and electrical infrastructures, found a robust solution with Skuid. Faced with the complexities of managing around 100,000 quotable products and detailed pricing rules, AFL transitioned from a costly, less adaptable CPQ […]
The Tow Foundation uses Skuid & Lightning to put people first.
The Tow Foundation is built on the simple but bold principle of investing in positive outcomes, and technology investments are no exception. With Skuid, The Tow Foundation reinvented how they managed grants and relationships, accelerated their Salesforce Lightning migration, and positioned their organization for growth. This advancement not only underscores their commitment to adopting cutting-edge […]
Request a live demo
See how you can manage, automate and optimize your business processes today ‐ get a demo from one of our experts.
Why Our Customers Trust Nintex on

Please wait while form loads...

Couldn't load the form.

Please disable your ad blocker or try a different browser. If you continue to experience issues, please contact info@nintex.com

Skip Navigation
Nintex
© 2024 Nintex UK Ltd