Case Study: a leading healthcare service providing company accelerates claims processing with Tungsten Automation Claims Agility

Healthcare Services Provider Automates Claims Processing to Seamlessly Absorb Booming Business Volumes

A leading healthcare service provider, which assists health plans and PACE organizations with operations and claims processing, faced significant challenges due to its reliance on manual data entry. This method was slow, error-prone, and created backlogs of up to four weeks, hindering the company's ability to manage its growing workload. To address this, the company partnered with Tungsten Automation and implemented its Kofax Claims Agility solution to automate the capture and processing of medical claims.

The solution from Tungsten Automation uses OCR to digitally capture and validate data from paper claim forms, automatically converting clean claims to EDI for processing. This has reduced average processing times by 30 to 50 percent, cutting a month-long backlog to under a week. The newfound efficiency allows the company to handle a projected four- to five-fold increase in monthly claims volume without adding staff, ensuring profitable growth and a more reliable service for its healthcare partners.