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Case Study: Data and AI

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A new federal law called The No Surprises Act was enacted in 2022. The law was designed to help protect people from many types of surprise bills for healthcare and banned surprise bills for emergency services from out-of-network providers or facilities without prior authorization. However, for health insurance companies to comply with these regulations, many had to shorten their document processing times from weeks to days.

Like many, our health insurance client did not have the infrastructure to support this regulation and to reduce its Provider Change Forms processing time down from weeks to days.

One department was responsible for processing Provider Change Forms received by email, fax, and postal mail. These forms were delivered from multiple states and expanded across thousands of providers. The Provider Network is an always-changing ecosystem; however, the infrastructure to support these changes has always required manual processing. As a result, the average turnaround time to process change requests is approximately 23 days.

Our health insurance client faced the challenge of taking their very manual method of processing provider change forms and shortening it to a goal of a 2-day turnaround time. They looked to SafeNet Consulting to help build a technology solution that not only reduced time and saved money but also freed up their team and improved their customers’ experience.

SafeNet assessed the client’s existing systems and data — the source, the type, the organization — and how useable the current systems and data were in their current state. Through the assessment, the team uncovered a new problem. The accuracy of Microsoft Azure Forms Recognizer heavily relied on clean PDF scans; however, Provider Change Forms primarily arrived in the department as scanned PDFs of the original form with varying readability levels due to smudges, low contrast, and dark spots. Without a pre-processing step, the information that Forms Recognizer used would be incomplete and incorrect, leading to low accuracy and reliability and ultimately requiring manual human intervention and time.

Assessment and recommendations provided a clear focus:

  • Need to build a pre-processing email application to clean up scans received by email, fax, and postal mail.
  • Utilize Microsoft Azure Forms Recognizer to extract the pre-processed forms data and create a file with changes.
  • Generate the file that would definitively update the Provider Portal with the accurate and vetted information.

SafeNet’s partnership helped the client to comply with the No Surprises Act, avoiding possible financial penalties and damage to the client’s image in the marketplace. In addition, this initiative helped them significantly reduce labor costs associated with the process, increase data accuracy, and increase overall member satisfaction due to the significant reduction in surprise bills.

The final result enabled the client to process increased volumes of Provider Change Forms without additional labor, while providing a better customer experience.

SafeNet has become an extension of the client’s team and continues to help them modernize many other departments that handle paperwork similarly.

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