Case Study
Digitizing Reimbursement, and Reconciliation Process for Leading Insurance Group
Enhancing Michigan Personal Injury Protection (PIP) Insurer's Billing Efficiency: Rapid Digital Platform Revolutionizes Reimbursement and Reconciliation process with Michigan Catastrophic Claims Organization (MCCA).
Highlights
Improve the efficiency and redesign the reimbursement and reconciliation process by creating a system that coups with rules mandated by Michigan State Catastrophic Claims Organization (MCCA).
The Billing team partnered with RNT to streamline the process of data collection for creation of Request for Reimbursement (RFR), Monitoring claims breach, Submission of RFRs and Reconciliation with MCCA over denied bills.
With the implementation of our application the average handling time required through the end-to-end process is reduced from 1.5 weeks to maximum 10 working hours.
Challenges
Leading P&C Insurer’s Claims Billing Department in search of solution to meet the MCCA guidelines and improve the PIP billing process.
The Key Challenges Were:
The
submission of Request for Reimbursement (RFRs) with seventy-one details on each bill
rather than the previously existing bill level of seventeen fields.Submissions of RFR
reports via “XML” and “Web Services” instead of RFR submission via excel
sheets.
Retrieval of response from MCCA on the submitted RFRs.Creation of
mechanism to calculate the accurate $ amounts requested, received, pending, and
accepted
as variance at each bill, RFR, and claim.response to these challenges, the Insurer collaboratively engaged with RNT to leverage the best mix of technology and meet the MCCA amends by improving the process as well as user experience hand in hand.
Solution
Introducing a semi-automated web application with custom built rules for data validation and data communication with MCCA
The application checks all claims to identify the retention breach. When the claim breach is detected, it is listed on application for biller’s validation and approval for initiation of RFR creation process
RFR Creation The application creates the requests for reimbursement forms for all breached and approved claims based on rules defined by MCCA. The mandatory validations by MCCA are checked and applied on the data in the RFR. Users are privileged to edit certain fields in the bills to fix the data per MCCA requirements.
RFR Submission To resubmit a RFR users must click a “Submit” button and rest can be taken care of by the application. The application is integrated with various webservices offered by MCCA systems which are used to automate the process of data transfer for RFR submission.
The application tracks the status of requested reimbursements using MCCA Webservices on a daily basis. Denied reimbursements are listed for user’s review.
The users are presented with a list of denied bills and the option to either resubmit the denied bills with changes allowed by MCCA or accept the amount variance.
The application continuously monitors and maintains the details of each claim, RFR, and bill for the amounts requested, received, pending, and variances accepted.
The dashboard module of the application facilitates summarized view of financial figure associated with reimbursement and Reconciliation process.
Business Impact
With the deployment of this application enabled the business users to seamlessly submit and track the Reimbursement and Resubmission request, and live reporting on the financials of each claim.
