Use Case - Healthcare Payer Systems
Automating Mission-critical Claims Processing to Achieve Compliance SLAs
Customer since 2007 – This insurance plan works with federal and state agencies to provide health coverage for diverse populations in four states. It has more than 1 million members and 3,000 employees
Challenges
Strict government-mandated deadlines
More errors as business and claim volume grew
Need to handle spikes in day-to-day activity
Inaccurate reporting from multiple inputs including customized claims processing app
Situation
Claims are received from insurance company partners throughout the day. Spikes in daily activity – 25,000 to 100,00 jobs per day – and growing claim volume require short- and long-term scalability. Accurate reporting that incorporates multiple inputs is essential.
The plan must submit claims it receives to government agencies by 9:00 a.m. the next business day. Breached deadlines result in financial penalties. The batch scheduler was not able to process the growing volume of jobs or integrate with the customized claims processing application. Deadlines were at constant risk of being breached.
Integrations Used
Results With Tidal
Operate in compliance with government deadlines – no SLA missed since deploying Tidal in 2007
Process 25,000 – 100,000 jobs/day flawlessly, increased from 6,000
Seamlessly integrate all inputs including proprietary claims processing application
Easily set up and run customized reports