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BSC Digital Intake.pptx

  1. © FIRSTSOURCE 2023 | CONFIDENTIAL | 1 Digital Intake Overview
  2. © FIRSTSOURCE 2023 | CONFIDENTIAL | 2 OverallMailroom& DataCaptureExperienceandCredentials Paper intake to electronic Sort, scan all types of Claims and non-claims Triage, member eligibility, index, print, outbound shipment, keyword search Color photo, X-ray, Legal, CD/DVD and other special processing Smart Data Capture, proactive validations, EDI Conversion Dashboard, reconciliation and reports PROCESSES 220M Claims Data Captured to EDI ~4B Pages Processed 100% Adherence to TAT 30 min to 48 hours 85% Claims Processed by BOTs 1,500+ Mailroom and Data Capture Examiners > 99% Quality Regional Mailroom Office (RMO) > 99.6% Critical Field Accuracy 30 min Provider Supply Chain TAT for Hospital Orders 350 Sort Types 4 hours Urgent Appeals TAT 12 hours Appeals Fax-line TAT 15 Clients
  3. © FIRSTSOURCE 2023 | CONFIDENTIAL | 3 DigitalMailroomandDataCaptureEndto EndProcessFlow • Envelope level prep • Minimize paper touch • Bots/AI technology PAPER SORT Smart Classification (Rightshore) SCAN • High speed scanners with rear imprinting • I-enhancement and 2D barcode • Special handling for X Ray and Color Photo DATA CAPTURE (Rightshore) Web, Email, FTP and other electronic input MAIL ROOM • Intelligent data capture with multiple OCR/ICR engines • Smart AI/ML algorithm for data comparison and accuracy • Rule based field level validations and form level (cross-field) data validations • Integrated with Healthcare Code Sets (CPT, CDT, ICD-10), business rules • API/File based integration for Provider and Member Lookup eUpload ENVELOPE INVENTORY CD Prep AI/ML MAIL PICKUP Smart Classification • Electronic sorts RPA/AI/ML • Document indexing and auto look-up • Minimal Human Touch • Smart Classification & Review • Accountable Mail, Dental, Vision • CD/DVD processing • Enrollment, return mail processing • Prior Auth, Medical Records, HEDIS • Correspondence, Checks processing Solution Differentiators Data Capture – Onshore/Offshore Delivery Center Image Shipment Data Shipment Dashboard Reports Storage & Shredding Firstsource Mailroom
  4. © FIRSTSOURCE 2023 | CONFIDENTIAL | 4 AI/ML-DrivenDataCapturetoReduceManualEffortandImproveAccuracy AI/ML Infusion Key Value Pair Extraction Intelligent Word Recognition Advanced Image Enhancement, Cleanup, and Extraction Cloud Portability EDI Transformation Capture Services - Document Types - Enrollment Forms - Authorization Forms - Medical Records (X-Rays, Photos) - HRAs/Checks - Claims & Correspondence - Channels - Faxes - Corporate File Shares - SFTP - Cloud Storage (S3) - Upstream Applications - Intake Portal (Prior Auth, Enrollment, Claims) - Business Process - API Gateways - Custom Applications - Email - Mailbox - Shared Folder - Mail Group - Outgoing Mail - Fax - Print Fulfillment - Business Process Platforms - HealthEdge, NASCO, WGS - Facets, QNXT - FileNet - Mainframe - Content Management Platforms - FileNet - Shared Drives - Data Output - XML - JSON - TIFF - PDF - NSF - ANSI X12 – 837I, 837P, 275, 277 CA Ingest Prepare Recognize Extract Normalize Validate Export
  5. © FIRSTSOURCE 2023 | CONFIDENTIAL | 5 ExtensiveExperiencein deliveringHealthcareDigitalIntakeservices One of Top 5 Health Plans in the US Leading Global Healthcare Supply chain exchanges A leading National Health Plan • Enrolling Hospitals and Vendors, Purchase Order Creation from Paper/Fax requests • Automation through workflow, OCR, and analytics platform. AI/ML solution to identify and redact confidential data • Global delivery: US, Europe, and India • Manage 5M+ orders manually • 85% reduction in processing TAT • 95% volume turned around in 30 mins • Urgent and Non-urgent appeals intake. Processing of appeals received through dedicated and non-dedicated sources • Sympraxis® smartly identifies Appeals based on keywords and processing guidelines augmented by AI/ML • TAT improved from 48 hours to 24 hours for all appeal types • Manage > 99.5% urgent appeals within 4 hour TAT • Digital Intake for Claims, Appeals, and Other Non- Claims documents for last 19 Years • Unique Engagement model & Proven Transformation Capability to each of the service lines • Introduced error proofing, process control, and workflow standardization • Manage 20M+ transactions annually • Data capture accuracy improved from 96.5% to 99%+
  6. © FIRSTSOURCE 2023 | CONFIDENTIAL | 6 UrgentAppealEfficiencyImprovementforoneoftheTop#5HealthPlans Volume per Month 1.5 M Non Keyable Volume Per Month 0.4 M Keyable Volume Per Month 1.1 M Appeal Volume Per Month 0.1 M Appeal Filtering Non-Keyable Audit Scores by BPQM Appeal Quality as part of NK Audit by BPQM 64 OOC errors reported in 5 months for 0.5M appeal documents delivered 100% 100% 99.987% Journey to “Zero Defect” Causes • Incorrect Lookup Selection • Non Standard Input • P&P Complexity • Cumbersome Keyword identification • SPOF – Human Errors Solutions • APIs for Lookup • System Validation • Role Assignment • AI / ML identifies Keywords • ML Smart Validation Striving to reach 6-Sigma levels
  7. © FIRSTSOURCE 2023 | CONFIDENTIAL | 7 DigitalMailroomProcessing Envelope Slicing Minimal Sorting Accountable Mail High Speed Scanning Outgoing Mail
  8. © FIRSTSOURCE 2023 | CONFIDENTIAL | 8 Fulfillment Outgoing Mail Solution • High speed Xerox printers for printing appeal acknowledgement letters, provider correspondence, member not found letters​ • High speed envelope inserters and Postage machine​ • Partnership with third party presort vendor for reduce postage.​ • Outbound express shipment utilizing USPS, UPS, Fedex
  9. © FIRSTSOURCE 2023 | CONFIDENTIAL | 9 WebandMobilebasedDocumentIntake- SympliSend Digital Document Intake - Web and Mobile Channel • SaaS Solution with Secure Login and authorization can be integrated with Health Plan’s Provider Portal and Provider Apps • Create patient records as single or a batch mode • Associate all documents with patient record • Generate Unique Tracking Number for each Document submission • Search and retrieval documents using the Unique Tracking Number • Submit and track documents using the Mobile Channel
  10. © FIRSTSOURCE 2023 | CONFIDENTIAL | 10 MobilebaseddocumentsubmissionwithSympliSend
  11. © FIRSTSOURCE 2023 | CONFIDENTIAL | 11 MailroomDashboardandAlertsonWeb
  12. © Firstsource Solutions Limited | Confidential | Helping customers stay ahead of the curve through transformational technologies and capabilities Firstsource Solutions Limited, a RP-Sanjiv Goenka Group company, is a leading provider of transformational solutions and services spanning the customer lifecycle across Healthcare, Banking and Financial Services, Communications, Media and Technology and other industries. Our ‘Digital First, Digital Now’ approach helps organizations reinvent operations and reimagine business models, enabling them to deliver moments that matter and build competitive advantage. With an established presence in the US, the UK, India and the Philippines, we act as a trusted growth partner for over 100 leading global brands, including several Fortune 500 and FTSE 100 companies.