Case Study: a leading provider of value-based home health TPA solutions accelerates claims processing with 3Pillar Global

a leading provider of value-based home health TPA solutions cuts claim payment time by 70% with 3Pillar Global

The customer, a leading provider of value-based home health TPA solutions, faced significant operational challenges due to its manual and inefficient process for reviewing healthcare authorizations and claims. This reliance on human review increased costs, hindered scalability, and slowed revenue growth. To address this, the company engaged 3Pillar Global to modernize its application and automate the complex adjudication process.

3Pillar Global developed a business rules management system (BRMS) to automatically approve claims that met specific parameters, handling 67% of submissions without manual intervention. For the remaining claims, they implemented a skill-based queue management application using jBPM to route work efficiently. This solution from 3Pillar decreased claim payment time by nearly 70%, increased auto-adjudication rates to 97%, and doubled the claims processing capacity of existing staff, leading to massive cost savings and improved scalability.