A host of complex decision-making situations have been captured to create new automated workflow applications. These applications become stand-alone or integrated components of a larger, enterprise or end-to-end automated process.
Each innovation was derived through a process of consulting experts from VestaCare’s claims payment automation team working with client operational and IT teams to identify, capture human-decision-making, map, test and deploy the following sample applications. By bridging the clients expert knowledge of plan administration with VestaCare expertise in Human-decision-making automation, the client’s knowledge base has been codified into solutions that create significant operational value, enhanced human productivity and secured retention of their unique process knowledge for years to come.
Payors: Innovative Automated Workflow Applications:
(“End-to-End Solutions for Perfecting Payment”)
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Enrollment Fatal Error Recovery: Enrollment data that initially fails loading into a claim system from the employer’s formatted file is considered a “Fatal Error”. VestaCare has created an automated load tool by teaching our patented “Automated Smart Examiner” to navigate the claim system and auto-key the enrollment data using repeatable processes. |
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Premium Billing Correction and Preemption: Enrollment data often arrives late or out-of-sequence by members, causing premiums to be mis-calculated and claims to be processed or declined in error. VestaCare has created a process to re-sequence inbound enrollment from all sources, synchronize the enrollment data with the claim system, adjust premium bills and identify any claims processed or declined in error. |
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Enrollment Data Accuracy Management: Claim processing is often completed manually for institutional claims as many claim systems are not set to capture every service line revenue code on a lengthy claim. VestaCare has developed automated claim loading tools that learn the specific revenue code bundling rules taught to your claim examiners, and auto-keys the claim service lines into any claim system. |
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Revenue Code Bundling: Optical Character Recognition is not capable of correcting provider billing errors (mis-use of fields, NPI information in wrong field). VestaCare’s data entry process has built-in edits to place data in the correct location for loading claims data into the claim system and avoiding claim “fall-out”. |