Transforming Provider Dispute Resolution with BPaaS Solution

Streamline Provider Dispute Processes, Enhance Operational Efficiency, and Reduce Backlogs

• Automated and streamlined provider dispute resolution using Inovaare’s BPaaS solution.
• Centralized data management for efficient case handling and resolution.
• Improved compliance monitoring and audit readiness with detailed reporting.
• Significant reduction in the backlog of provider dispute cases.

Quantifiable Results

• 94% reduction in open provider dispute cases from over 2,500 to less than 150.
• Peak productivity achieved, processing a high volume of cases per person per day.
• Zero cases reopened due to errors, maintaining high accuracy.

The client is a leading health plan based in Tennessee dedicated to offering high-quality healthcare services. Focusing on member satisfaction and regulatory compliance, the customer sought to improve provider network operations by reducing backlogs and improving resolution times.

Before partnering with Inovaare, the health insurance provider faced several significant challenges:

• Substantial backlog of over 2,500 post-service contracted provider dispute cases, straining operational resources and efficiency.
• High volume of open cases potentially impacting provider relationships due to the growing backlog.
• Complex dispute process requiring meticulous examination and compliance with regulatory guidelines.
• Need for experienced professionals and clear process guidelines to handle specific project demands consistently.
• Requirement for streamlined access to critical systems to ensure smooth onboarding and productivity.

The health insurance provider decided to adopt Inovaare’s BPaaS solution to enhance their provider dispute resolution processes. Their specific goals included:

• Automate and streamline the provider dispute resolution process to reduce manual effort and errors.
• Ensure data consistency and improve case handling efficiency with centralized data management.
• Enhance compliance and audit readiness with detailed reporting and adherence to regulatory guidelines.

After evaluating several technology solutions, the health insurance provider selected Inovaare’s BPaaS solution due to its robust automation capabilities, experienced staff, and comprehensive data management features. The key aspects of the solution deployment include:

• Inovaare quickly grasped the customer’s complex provider dispute processes and integrated effectively with their existing systems, collaborating closely to establish guidelines and ensure smooth operations.
• A dedicated team of skilled analysts, auditors, and registered nurses brought valuable expertise in healthcare processes and dispute resolution, working diligently to close cases accurately and efficiently.
• Leveraging expertise, Inovaare implemented a streamlined workflow and best practices to handle the high volume of cases efficiently, providing training and support to meet productivity expectations.
• The solution emphasized adherence to regulatory guidelines, maintaining comprehensive audit trails, and providing detailed reporting to ensure readiness for compliance audits.
• The solution adapted to the customer’s evolving needs, demonstrating the ability to handle a substantial backlog of complex cases with a scalable team structure and a combination of onshore and offshore resources for optimal coverage and cost-efficiency.

The implementation of Inovaare’s BPaaS solution provided the health insurance provider with unprecedented levels of efficiency and accuracy in their provider dispute resolution processes, leading to numerous benefits:

• Automated processes and streamlined workflows significantly reduced manual effort and errors, ensuring cases were resolved quickly and accurately.
• Detailed reporting and comprehensive audit trails enhanced compliance monitoring and audit readiness, enabling proactive management of regulatory risks.
• The automation and centralization of data management reduced the need for manual interventions and follow-ups, leading to substantial cost savings.
• Maintaining high accuracy ensured no cases were reopened due to errors, increasing trust and reliability in the dispute resolution process.
• The solution’s scalable team structure allowed for quick adaptation to increased workload, ensuring continued efficiency and productivity.

The implementation of Inovaare’s BPaaS solution led to significant and measurable improvements for the health insurance provider:

• 94% reduction in open provider dispute cases, reducing the backlog from over 2,500 to less than 150.
• Peak productivity achieved, processing a high volume of cases per person per day, surpassing expectations.
• Zero cases reopened due to errors, maintaining high accuracy and reliability.
• Team size nearly doubled to handle increased workload efficiently, showcasing scalability.
• Enhanced compliance and audit readiness by adhering to the highest industry standards and regulations, ensuring readiness for compliance audits.