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Health Management organization sees 75% reduction in time to establish new networks

Scott & White Health Plan and Insurance Company (SWHP), headquartered in Temple, Texas, is a health maintenance organization (HMO) with more than 215,000 members. SWHP is part of Baylor Scott & White Health, whose history of healthcare service in Texas dates back to the late 19th century. Scott & White Health Plan is the highest-rated plan in Texas and one of the highest-rated plans in the nation. SWHP is consistently recognized for member satisfaction and enjoys a national reputation for excellence.

The payer sought a better way to insert raw data into their systems and improve efficiency in a variety of manual data processes in order to save time and money. “There is a large volume of manual data entry that is part of our job. A lot of copying and pasting of data,” said Chris Gengo, Director of Operations Systems for Scott & White.

Company
Scott & White Health Plan and Insurance Company
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Industry
Health & Life Sciences
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Who they are

Scott & White Health Plan and Insurance Company is a health maintenance organization headquartered in Temple, Texas. SWHP is rated one of the highest-rated plans in both Arizona and the Nation, with over 215,000 members.

What they needed

SWHP was looking for a more time- and cost-efficient way to insert raw data into their systems and improve efficiency when completing manual data processes.

How they did it

SWHP adopted Nintex Foxtrot® RPA to improve efficiency and accuracy when inputting raw data. SWHP has found a 75% reduction in time when completing tasks like pay class set-up, provider network creation, and more.

The challenge

Scott & White’s current processes, plus a potential influx of new applicants from the passage of the Affordable Care Act (ACA), meant significant time would be spent manually entering and changing data in their core system for things like pay class set-up, establishing new provider networks and more.

In a process that took as many as four weeks to perform, Scott & White’s team would create networks by manually copying and pasting rate, service, and other information from a similar plan into the new ones. New pay classes were created the same way, often occupying as much as 45 minutes of a worker’s time per job.

The RPA solution

Already a Nintex Foxtrot® RPA customer, Scott & White automated the task of performing pay class set-up, provider network creation, and much more. Nintex Foxtrot® RPA works in the presentation layer (the user interface) of most core systems by punching keys and moving data just like a person would, but much more accurately. In so doing, Nintex Foxtrot® RPA takes much of the time-consuming manual work off SWHP employees’ hands and frees them to handle other projects.

Nintex Foxtrot® RPA now needs just one week to establish new networks in a simple copy-and-paste process – a 75 percent reduction in time. Establishing new pay classes, a chore that had taken up to 45 minutes before Nintex Foxtrot® RPA, now takes just five minutes when done automatically. This is all done with total accuracy.

Nintex Foxtrot® RPA handles claims, too. Those affected by retroactive pricing changes are now re-run automatically, regardless of whether the claim is in-process or completed. The software automatically credits the physician’s account and issues a check for the fee difference rather than occupy a full-time employee. “There’s rarely a day where there is not some Nintex Foxtrot® RPA script running here,” said Gengo. “We’re a small shop for a plan of our size. One of the reasons we’re able to be so productive with a small team, and even scale our operation quickly without adding headcount, is because we have an automated solution.”

One of the reasons we’re able to be so productive with a small team, and even scale our operation quickly without adding headcount, is because we have an automated solution.
Chris Gengo, Director of Operations Systems, Scott & White

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