Healthcare Claims Automation Case Study – Highmark Health

Forty million customers in the eastern United States count on Highmark Health to deliver essential healthcare-related services. As one of America’s largest Blue Cross Blue Shield insurers, they care deeply for their patients and aim to deliver a high-quality patient journey. Their Living Health model uses technology to simplify the processes that often complicate the patient, clinician and employee experience. So, to help free staff from burdensome tasks, they brought in a team of Blue Prism digital workers.

Challenge

To meet its mission to “create a remarkable health experience, freeing people to be their best,” Highmark Health looked to reduce staff time spent on mundane tasks and increase time spent on patient care. But COVID-19 introduced additional challenges and disrupted “normal” business operations. By waiving COVID-19-related fees for all members, manual labor processes hit an all-time high; 10,000

COVID-19 claims needed to be processed daily. Highmark Health had to rapidly change its claims handling processes, while managing the new remote working environment.

Solution

When the pandemic began, Highmark Health was already two years into an enterprise transformation program called thinkUP that examines the value of technology to solve business challenges and seeks to expand the impact of each employee’s talent within the organization.

The automation team under thinkUP has implemented Blue Prism digital workers to improve everything from audit and compliance processes to machine learning risk assessment. Employees quickly saw the benefits, and concerns about digital workers’ impact on their job security quickly settled.

This company-wide automation adoption was a huge benefit to COVID-19-related challenges. Within a few days of working with leaders from Health Plan Operations, HM Health Solutions and Identity and Access Management, Highmark Health developed three digital workers to process COVID-19 claims and waive fees for members and providers. The digital workers, which were free as a part of Blue Prism’s COVID-19 relief program, were released in six days, versus the typical six- to eight-week time frame.

Highmark Health increased efficiency and accuracy, quickly cleared their backlog, and processed over 200,000 claims in just five days. They continue working diligently, and their success is evidenced by the 2.1 million patient claims that have been paid. The digital workforce has scaled to assist with 130 processes, and the team can implement new processes quickly by reusing code or utilizing the Blue Prism Digital Exchange. thinkUP has since formed the foundation of a subsidiary organization called Lumevity, which is helping companies outside of Highmark Health drive transformation programs using automation solutions in concert with org-and-op model redesign, change management, employee activation, and ideation.