3Pillar Leads Lab Tech Company to Benefits of Automation and Digital Solutions

A leading Lab Insights company equips healthcare providers and insurance companies with a suite of products that ensure only the necessary lab tests for a patient are ordered and approved based on that patient’s symptoms and diagnoses. Even though healthcare is highly regulated, there is still tremendous amounts of waste when it comes to running lab tests in the US and processing the associated claims payments. Data has shown that 30% of lab tests in the US are unnecessary, and another 30% of patients don’t get the tests they actually need.

Challenge:

3Pillar Created a Digital System to Eliminate Waste and Avoidable Errors in Processing Claims

The company faced a number of challenges when we began working with them. Chief among them was the need to automate the handling and updating of more than 40 lab policies, each with its own complex workflow involving clinical resources, medical coders, and the policy teams that were responsible for determining which tests were necessary for which diagnosis. Each of these policies had to be updated quarterly for more than 20 clients across a variety of disparate systems.

The general workflow that we helped them automate and digitize was this:

• Claims were submitted to the company by their clients, who are payers and health care plan providers
• This information was then processed manually through a combination of Jira, Smartsheets, Excel, Microsoft Word, and other applications, where it was cross referenced against the latest coverage codes from Medicare, Medicaid, and insurance companies
• These processes required manual review and data entry every step of the way. This introduced possibilities for human error that are costly and labor-intensive to correct, especially after they’ve been denied by insurance companies for incomplete or incorrect information

They were also dealing with the ongoing challenge of manually reviewing and inputting HSA payment data that came to them in a variety of formats, including emails, scans, faxes, checks, and credit card summary statements. These manual reviews of HSA data were not just time-consuming, they also allowed for human error when inputting claims and payment data.

Solution:

3Pillar Built a Custom Application From Scratch and Tapped Into Robotic Process Automation to Rapidly Accelerate Payment Processing

We collaborated with the company to build an end-to-end clinical workflow management platform exposed to external users for products and offerings and internal users for operational automation and excellence. The platform addresses the challenge of making frequent updates to 40+ policies across more than 20 clients. For the company’s customers, i.e. insurance companies and payers, the platform provides them with a website where they can go to access their historic as well as current lab policies, which can be published on their websites as well. For the company’s internal team, the platform has completely replaced the manual workflows and patchwork of applications they previously relied upon to serve their customers. 

Due to the manual and highly repetitive nature of the work the company was doing to manage incoming HSA payments data, our team identified Robotic Process Automation as a viable solution to a number of their challenges. We designed and created an attended bot in UiPath that automates data extraction from checks and credit card statements using OCR and AI algorithms, then inputs the extracted information into a predefined template that only accepts benefit codes it knows to be valid.

Outcome:

Custom Clinical Management Platform and Attended Bot RPA Solution Lead to Dramatic Reduction in Manual Labor, Inaccurate Data, Rejected Insurance Claims

The solutions we’ve worked with the Lab Insights company to build have driven clear success for their business. Just a few of the highlights of our work together are:

• Clinical workflow management platform reduced the time required for end-to-end claim processing by 65%
• A 90% reduction in weekly time spent manually entering claims data.
  • Decrease from 20+ hours/week of data entry to 2 hours/week performing quality control of automated data
• Complete elimination of inaccurate or incomplete data thanks to creation of an application that requires accurate codes to be entered before a claim can be processed

Our work as a true technology partner to the company has helped them continually elevate their ability to serve their customers, while also freeing their own team up to focus on providing higher value strategic work and reducing the costs necessary to process claims data.