Case Study: OpenGate (Insurance and Healthcare)

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 throughput and reducing time and eff ort 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 fi ve 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 fi ve minutes—a 67% decrease.


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