Select Health’s vision is to deliver high-value health insurance benefits and superior service at an affordable cost. It’s a tall order, but Select Health is up to the task. For 40 years, the company has been serving one million members with a range of healthcare plans. When a member receives a bill for inadvertently seeking care out-of-network, employees must manually request approval from managers to help the customer resolve the issue. To streamline this process and reduce paperwork, Select Health looked to SS&C | Blue Prism® Chorus BPM.

Challenge

An unexpected medical bill is often an unwelcome surprise. Select Health members receive a bill for a variety of reasons, like accidentally visiting an out-of-network doctor or pharmacy. Or, Select Health may have mistakenly denied a member for a service that was approved by the member’s healthcare provider. Employees strive to quickly resolve this situation for customers via an internal exceptions process. However, the exceptions process was paper-based, so it was difficult to rapidly handle any issue. When a concerned customer called in, a representative spoke with the customer and then wrote a detailed report and submitted it to a supervisor for approval. The request often had to gain additional approvals from upper management, depending on the cost of the service. It was a very manual process, which might involve walking from desk to desk until the request was ultimately signed and approved for payment. And since there could be 700 requests per month, it was easy for them to get lost in the shuffle of paperwork on managers’ desks. After the request was approved, member service representatives had to manually move it through internal systems to ensure the member was paid.

Solution

Select Health uses SS&C Blue Prism Chorus Business Process Management (BPM) and has found it to be the perfect tool to handle the exceptions process. Now when customers call in with an unexpected medical or dental bill, representatives create an exception request in Chorus. They pre-populate member information fields with details from internal databases and automatically connect the original claim to the new request.

The exceptions process has been transformed. Employees no longer have to walk paper requests around the office and track down the appropriate manager. The request is simply deposited in the appropriate queue in Chorus and routed for approval to pertinent managers. Chorus also sends email notifications to managers with an embedded link to ensure they review and respond to the request In a timely manner. Once approved, Chorus automatically routes the claim to be adjusted and the request is resolved.

Best of all, nothing gets lost. Each request is easily tracked in Chorus. Employees can check Chorus at any time to update customers on the status of the request. They’re empowered to provide excellent customer service, and customers have a quick resolution to a potentially stressful situation.