Automating Healthcare Data Management: A Case Study of Care1st Health Plan Arizona
Technology Category
- Analytics & Modeling - Robotic Process Automation (RPA)
- Application Infrastructure & Middleware - Event-Driven Application
Applicable Industries
- Finance & Insurance
- Healthcare & Hospitals
Applicable Functions
- Maintenance
Use Cases
- Usage-Based Insurance
Services
- System Integration
- Training
About The Customer
Care1st Health Plan Arizona is a Phoenix-based healthcare provider that offers coverage to beneficiaries of the Arizona Health Care Cost Containment System (AHCCCS). The organization recently expanded its services from Maricopa County to Pima County, increasing its enrollment from approximately 50,000 to over 70,000 individuals. In addition to this, Care1st Health Plan Arizona was also named as a Third Party Administrator (TPA) for Arizona’s insurance cooperative offered through the new National Health Insurance Marketplace, which meant they were preparing to handle potentially thousands of new enrollees and provider records over the coming months.
The Challenge
Care1st Health Plan Arizona, a Phoenix-based healthcare provider, faced a significant challenge when they expanded their services from Maricopa County to Pima County. This expansion increased their enrollment from approximately 50,000 to over 70,000 individuals almost overnight. The organization had to quickly update or add line-of-business records, provider panels, and other records to ensure continuity of coverage and reimburse providers. Additionally, as a newly-named Third Party Administrator (TPA) for Arizona’s insurance cooperative offered through the new National Health Insurance Marketplace, the organization was preparing to handle potentially thousands of new enrollees and provider records over the coming months. The organization traditionally used up to 15 different macros per day to perform large data entry and maintenance tasks, but these were unreliable and required constant monitoring. The small provider data management team was often pulled away from their daily work to manually enter smaller jobs of fewer than 200 records.
The Solution
To address these challenges, Care1st Health Plan Arizona turned to Nintex Foxtrot RPA to automate the process. Nintex Foxtrot RPA software replaced their inefficient macros and automatically executed the multiple data-related tasks that cost them time and productivity. In Nintex Foxtrot RPA, Care1st hired an “automated employee” who handles virtually anything their current employees perform with a mouse and keyboard, but with better speed and accuracy. The software's Smart Scripting technology made it easy for anyone to write and execute scripts in the presentation layer of almost any application. The team was able to automate routine tasks even before the three-hour basic training that was included with their investment. The software was used to update more than 43,000 provider records automatically, update physician panel sizes, reprocess and approve claims, and update NDC codes.
Operational Impact
Quantitative Benefit
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