APS Medical Record Summarization for BGAs

Challenges

The Attending Physician’s statement (APS) is a core underwriting asset. APS medical record review demands a major share of the underwriter’s time. One of the leading BGAs in the US, sought to reduce medical records review time as well as improve the time for the Risk Appraisal process. Their goal was to have these intricate processes completed without compromising on Quality, Consistency, and Turnaround time.  The BGA wanted to develop a workflow solution and also outsource the medical record summary service to a single service provider who could handle an end to end migration. This involved the provider understanding the process, then developing a robust process flow and standard training tool for knowledge transfer. The challenges they had hitherto encountered in the Migration Process were:

• Addressing all HIPAA regulations stringently to ensure confidentiality and security of health information
• Time and Resource Challenges in Recruitment and Training of employees on the Migrating process
• Standardizing the procedures involved in Summarization & Risk assessment
• Formulating Standardized procedures to procure accurate statuses from facilities

Our Solution

• eNoah’s end-to-end understanding of the Insurance business helped us get to the core and analyze the BGA’s key issues in developing workflow and standardizing the process and procedures. This resulted in a quicker transition.
• The robust knowledge transfer tool we developed helped eNoah to Go-live within a short period from the date of the training. As the extracted versus overlooked information in a medical record goes right to the bottom line of insurers, eNoah deployed resources to run 100% Quality checks.
• The Internal Quality Assurance team at eNoah helped standardize the process and ensure summary accuracy through frequent training.

Key Benefits

• Provided better visibility to the process through Web-enabled workflow. This resulted in insurance agencies having uninterrupted access to the updated status of summarization and related queries.
• Prompt and timely summarization resulted in a reduction of time in the Risk Appraisal process.
• Helped our clients concentrate on their core business while eNoah handled the medical underwriting.
• Helped achieve significant cost benefits on account of having a single service provider to address core business needs.
• As a result of a better process, 80% of summaries were delivered within 24 hours and the remaining 20% within 48 hours.
• The Internal Quality Control team at eNoah improved Process efficiency and enforced standardization of procedures for summarization.
• Customized summaries were provided as needed by the client.
• Fulfilling the demanding internal Quality Assurance recommendations provided by the team improved the overall rating of the summary.