Case Study

AI-Powered Retrieval for HEDIS

July 23, 2024

By , ,

Automating provider outreach to accelerate medical record collection

Business Challenge

A leading healthcare services firm played a critical role by providing medical record retrieval support for health plans to meet HEDIS deadlines. The company wanted to drive efficiency through their processes and targeted provider outreach as an area to transform due to the manual and time-consuming methods to retrieve records, such as manual address validation and repetitive phone calls. The company prioritized approaches to automate the process to enable them to support more customers and higher volumes of medical records.

Key Highlights

AI-powered retrieval

Provider outreach automation

1,400 hours saved

Solution:
Optimizing Provider Outreach

Faced with managing a high volume of provider outreach for multiple health plans, the firm was searching for ways to automate and add efficiency. For example, manually assembling and editing provider packets added work and slowed outreach. Batch uploads required manual file reassembly, and spreadsheet reconciliation increased the risk of errors.

To overcome these limitations, the firm adopted Reveleer’s platform to streamline provider outreach with AI and intelligent automation:

Automated Outreach Workflows: A SQL process automatically identified chases meeting specific criteria and triggered outreach requests. This eliminated the need for manual assembly and batch uploads, reducing errors and accelerating dispatch times.
Streamlined Communication: Automated follow-up statements minimized the reliance on phone calls and improved retrieval rates.
Enhanced Data Focus: The platform flagged validated addresses so users could focus on potentially inaccurate addresses, to streamline manual verification for faster turnaround.

17,249

Statements Delivered

25%

Packets Delivered Automatically

3 Weeks

Faster Packet Delivery

50%

Fewer Provider Outreach Attempts

A Path to Future Success

By automating provider outreach processes, healthcare services firms can achieve significant efficiency gains in HEDIS retrieval. This translates to faster turnaround times, improved retrieval rates, and a more streamlined user experience. As the focus on data validation expands, these improvements will allow the firm to manage higher volumes of records maintain their competitive edge.

1,400
hours saved

50%
more efficient outreach

26%
higher retrieval rates