Data assurance for health insurance
Health insurers rely on third-party data to ensure all the right parties pay for patients' healthcare before the final bill goes out. Without good Third Party Liability (TPL) data, our client was susceptible to overpaying for insurance claims. This was a major issue for members, not to mention a point of friction with providers.
Then our client found out the hard way that the third-party data feeds they used—and paid over $10 per record for—were permeated with inaccurate data.... and those data errors were costing them big.
At the end of their rope with knotted-up data
Our client was plagued by:
- Lack of record-sharing between plans, states, and organizations
- Data feeds suddenly changing format without notice, disrupting automated reporting
- Difficulty ensuring that data feeds were monitored for quality and schedule adherence
- Antiquated infrastructure
- Service interactions that often took over 15 days to process, impacting provider and member satisfaction
These challenges contributed to costly manual rework, provider friction, and member frustration.
Our client’s leadership saw enormous potential to improve their TPL function through digital transformation and the use of AI. If they could capture new data sources and automate error detection and workflow, they could significantly reduce manual effort—but they weren’t positioned technically to seize those opportunities.
Untangling TPL records in one smooth solution
Healthcare industry knowledge and world-class AI and cloud specialists made Launch the right partner to tackle this challenge. More importantly, our focus on the human experience helped us collaborate with our client to challenge and remedy healthcare service norms that were out of touch with the kind of experience today’s members and providers expect and deserve.
We started with a top-to-bottom review of our client’s process for ingesting and curating TPL records. Engaging their SMEs, Launch devised a strategy to completely redesign that process, and delivered a cloud-based solution built on AWS. We also leveraged an AI Business Rules Engine (BRE) to ingest and curate these records with a more efficient, automated process.
Data: sorted, organized, and ready to use
This cloud-architected, AI-enabled TPL solution:
- Established a business rules governance process that formalizes how our client makes changes and curates their data
- Identified severe data feed troubles for correction and prevention - 60% of incoming data had existing quality issues
- Automatically monitors information from data feeds for quality and schedule adherence
- Provides data lineage to help the team justify all curation decisions
The new solution allows our client visibility into the data they use to make their decisions and exactly where the data came from. Their team can now answer customer questions more quickly, and with a much higher degree of confidence.
Moving toward seamless, connected healthcare
This Launch-architected solution supports 60 transactions per second, and can scale to over 500 million claims per year. The client anticipates the solution, with all the above described capabilities, will pay for itself within the first six months of operation by reducing the number of incorrect TPL or coordination-of-benefits decisions by 90%, and associated TPL-related manual labor by 80%.
Better data makes for more reliable decision-making, faster action, improved relationships with providers, and, most importantly, enriched member experiences—all with less work.
That’s a win-win-win in our book.