Case Study

Accelerating Retrieval to Meet Audit Deadlines

June 11, 2024

By , ,

Saving more than a thousand hours of manual document preparation for a large state Blues Plan

Business Challenge

A large state Blue Cross Blue Shield Plan struggled to meet audit deadlines because of manual, cumbersome retrieval processes, even after hiring and training new contingent workers each year.

The plan’s new IVA leadership realized how much its processes required hands-on action by individuals. Managers had little visibility into the program’s real-time progress but realized that, without technology, they would be unable to cover the volume of records within the time allowed before the audit deadlines.

Key Highlights

AI-powered Retrieval to accelerate record collection

+1K hours saved

50% reduction in total staff

Solution:
Reveleer’s AI-Powered Retrieval Solution

While working with more than a 100K providers and practitioners in a state with low Electronic Health Record (EHR) participation, the Blues Plan received medical records by mail, email, and fax. Records had to be reviewed page by page and required four contingent workers more than 2,250 hours to review, in addition to another 250 hours spent manually editing more than 1,500 provider packets. Data was upload into outdated SQL databases across multiple batches, with some files having to be manually "reassembled" in order. Finally, reconciliation was tallied via spreadsheets and took more than 120 hours to complete.

Reveleer's AI-powered Retrieval solution accelerated the health plan's retrieval efforts, by automating tasks like records processing, outreach and chart reviews, significantly reducing manual efforts. The platform's Provider Gateway facilitated seamless data exchange, empowering providers to upload charts effortlessly.

84%

Reduction in Manual Chart Reviews

1,100

Hours Saved Processing

50%

More Efficient Provider Outreach

30%

Faster Chart Review

Sharing Data Across an Expanded Program

Adopting Reveleer has transformed retrieval for the Blues Plan. The combination of AI and capabilities like the Provider Gateway have eliminated manual workflows and positioned the health plan for continuous improvement. With the Reveleer platform the team hit internal milestones ahead of schedule and drove a smoother audit process. Leadership anticipates their processes will get even faster in future audit cycles.

53%
faster medical record retrieval turnaround time

75%
reduction in chart review staff

50%
reduction in outreach staff