Laya Healthcare is the second largest healthcare insurer in Ireland, with more than 600,000 members, and it is committed to providing excellent coverage and delivering positive health outcomes for each one. Laya receives tens of thousands of healthcare claims each year. And a high volume of them were duplicates. The insurer knew it would be time-intensive for human workers to remove all duplicate claims, so its teams were equipped with Blue Prism Decipher IDP (Intelligent Document Processing) to tackle the task.

Challenge

Like any large health insurer, Laya receives tens of thousands of claims each year. Often, after the claim has been paid to the requestor, a subsequent claim is sent to Laya. For example, if the requestor didn’t bill for an X-ray when the initial claim was filed, the X-ray still needs to be associated with the initial claim. And it needs to be paid in a timely manner. These follow-on claims were stacking up and Laya staff didn’t have the resources to immediately deal with them, which meant additional duplicate claims were sent the next month. In some cases, a single claim was being resubmitted up to four times, which added to the backlog.

Solution

Asking employees to manually sort through a large volume of claims to find duplicates is not only time-consuming but costly. So instead, Laya tapped into their Blue Prism digital workforce. Equipped with Blue Prism Decipher IDP, the digital workers use optical character recognition on both structured and semistructured documents to identify duplicates.

How do they do it? A digital worker opens each invoice (a pdf) and extracts the details using Decipher. Next, it checks Laya’s database to determine the claim ID associated with the invoice and matches it to an existing claim. If the claim is found to be a duplicate, the digital worker closes the duplicate and moves on to the next invoice. If the invoice is found to be unique, the digital workers check the invoice against a list of approved procedure codes. Digital workers then open Laya’s internal CMS tool, add new items to the existing claim, and authorize the new items for payment. This means Laya has claims that are validated on arrival, assessed, and closed out by digital workers – with no human interaction whatsoever.

With an estimated savings of more than a minute per claim, Laya has already returned 450 hours back to the business in January 2022 alone. This means the insurer can deal with its duplication backlog and pay claims more quickly without having to hire additional staff. Laya has scaled intelligent automation widely across the organization, with 119 processes running in claims, business development, customer experience and HR.

Download this case study on IDP in Healthcare and invoice deduplication