As corporate health insurer CNU’s business boomed, reliance on manual medical bill analysis slowed turnaround times and drove up costs—threatening to delay critical payments.
CNU can process some 1.3 million medical bills a month more quickly and accurately than ever, thanks to digitized content and automated processes, driven by IBM Enterprise Content Management software.
90%lower administrative costs, boosting profitability
10%faster processing of medical bills, resulting in timelier payments
35%less time spent analyzing bills, freeing staff to take on more work
Business challenge story
Taking the pain out of bill processingCentral Nacional Unimed (CNU) markets corporate medical care plans, special benefits and specialized care to some of Brazil’s biggest companies. CNU primarily serves large national enterprises, operating in a minimum of three states and covering at least 300 beneficiaries (both policyholders and dependents). It also works with a number of small and medium-sized enterprises. Today, CNU has more than 1.6 million customers throughout Brazil.
Every month, CNU processes an average of 1.3 million medical bills on behalf of its beneficiaries, of which 120,000 come with supporting documents. The process is a complex one—analysts must evaluate the bill based on a number of factors, such as days spent in treatment, types of services and supplies used, diagnoses and more, in order to determine whether they will pay the entire bill, a portion of the bill, or if they will deny the bill outright.
Previously, CNU relied on largely manual methods to evaluate medical bills. Not only was the process time-consuming, it came with a high risk of error; all of which threatened to prevent CNU from reimbursing healthcare providers promptly and accurately.
With business volumes growing steadily, CNU knew that the days of manual processing were numbered.
Felipe Garcia Rios, Systems Consultant at CNU, elaborates: “Delays were becoming increasingly common, and costs were rising as we had to take on more staff. We could not afford to keep throwing resources at the problem, and needed to find a way to make processing more efficient. This would allow us to analyze bills faster and scale up to handle rising workload.”
Going digitalCNU overhauled its approach to medical bill processing, embracing IBM Enterprise Content Management solutions to digitize documents and automate workflows. In less than six months, the company was able to transform mountains of paper files into a rich store of electronic content and introduce an advanced case management platform that streamlines medical bill analysis and processing.
Felipe Garcia Rios comments: “Unlike other vendors, who could only offer a mix of point solutions, IBM was able to deliver the complete package. We got everything we were looking for in a single, integrated platform.”
Today, when CNU receives a bill, it scans the document and uses an IBM® Datacap solution to automatically capture and index key information from the electronic file. All of the digitized bills are stored in a central IBM FileNet® Content Manager repository.
IBM Case Manager provides analysts with a single point of control for processing medical bills. From one screen, users can view all the information related to a particular item, including a detailed breakdown of procedures and prices, along with a copy of the original medical bill itself. CNU has also established a series of task workflows that guide analysts through every step they need to review and process a bill.
The Case Manager platform is seamlessly integrated with FileNet Content Manager and CNU’s core enterprise resource planning (ERP) system, giving analysts easy access to a wealth of data on payments, customers and providers.
Gearing up for growthCNU’s new approach to medical bill handling has supercharged the productivity of analysts and enabled them to work in a much more flexible way.
“Moving away from paper has completely changed the way that people work,” states Felipe Garcia Rios. “Our analysts no longer need to hunt through boxes and filing cabinets to find the information they need; all they have to do is perform a simple search and the relevant content will appear on their computer screen. And as multiple people can access the same documents simultaneously, there’s no need to wait around for specific records, so analysts can get right down to work.”
He continues: “With easier access to content and more automated processes, our analysts can manage their workload much more effectively, and get through a much higher volume of work than before.”
The efficiency gains have translated into shorter cycle times and impressive cost savings, as Paulo Januzzi, Director of Healthcare and Exchange, explains: “Since introducing IBM Enterprise Content Management solutions, we have reduced the time taken to analyze medical bills by 35 percent, and have shortened the average processing time for bills by 10 percent. The result is that analysts can make timelier decisions about paying bills and CNU can reimburse healthcare providers faster, helping us maintain positive relationships with these partners.
“What’s more, by minimizing our use of paper and making other process improvements, we have been able to cut administrative costs by 90 percent. This has delivered a huge boost to our bottom line.”
Embracing electronic content and workflows has enabled CNU to break down the barriers to growth, enabling the company to scale up operations to manage rising business volumes without increasing headcount.
Felipe Garcia Rios notes: “We have taken medical bill processing to the next level with IBM Enterprise Content Management solutions. Teams are working faster and more accurately, and we have been able to handle a much higher workload without taking on additional staff. We now have the solid foundation we need to keep growing our business and deliver consistently excellent service to our partners and customers, who rely on us for cost-effective access to healthcare.”
About Central Nacional Unimed
The Central Nacional Unimed (CNU) sells and manages health insurance plans on behalf of Unimed—Brazil’s largest healthcare cooperative. Established in 1998, CNU serves more than 1.67 million customers and employs over 1,400 people.