Case Study: a leading national health plan reduces UM and CM handling time with EXL's DigiCA

How DigiCA added value, speed, and efficiency in utilization and case management and saved over $2 million for a client in two years

EXL worked with a leading national health plan that was burdened by manual utilization and case management work. Nurses had to move through 15–20 screens, review many fields for eligibility and verification, and rely on multiple spreadsheets and complex tasking rules across more than 80 case types, creating slow, inefficient processes and high operating costs. EXL used its DigiCA solution to help reduce this non-value-added effort and simplify clinical review and case routing.

EXL implemented DigiCA to automate member verification, extract information for case summarization, and assign cases to nurses based on skill set, supporting 200 nurses across commercial and Medicare queues with 24/7 production support. The result was a digitally transformed UM and CM operation, with more than $2 million in net savings over two years, a 25% reduction in handling time for nurses, and a 30% reduction in handling time for case managers.