Case Study: Large Health Plan Company achieves $3M+ savings and 84% instant automated approvals with ZeOmega's Jiva

Automating the Authorization Process Saves a Large Health Plan and its Providers Millions 6200

Large Health Plan Company, which covers about 4 million lives, needed to streamline its authorization approval process — only about 55% of requests were auto-approving and complex cases could take days. To meet a goal of higher automation and lower administrative burden, the plan implemented ZeOmega’s Jiva population health management solution to automate submission and review of supplemental clinical information.

Using ZeOmega’s Jiva (including the Sentinel Rules Engine and online clinical forms), the plan configured auto-approval rules and automated medical review scoring, removing manual intervention for 84.4% of electronic submissions (up from 55%) and enabling 80% of commercial requests to be turned around within one day. The automation delivered roughly $3 million in plan savings in 2015, an estimated $10.7 million in provider administrative savings, and positioned the organization to drive provider adoption above 91%.