Case Studies

 Process Automation

Project	Hospital Claims Process Automation Study
Client	Health Insurance Fund
Objectives	To identify opportunities for improvement in the client’s hospital claims processes, and to determine the feasibility of implementing “straight-through” processing of claims between the hospital and the insurer.
Pragmat Role	Pragmat carried out a detailed end to end analysis of the client’s hospital claims processes. The deliverables included: process maps and narratives describing each step of the target process; a written analysis identifying process issues, their impacts and their causes; and: recommendations for process design changes to remedy the identified process issues.  Pragmat also conducted a requirements analysis for straight though claims processing as well as a technical feasibility study.
Outcomes	The outcome from this project was a plan of action for our client to implement process and organisational changes, as well as a blueprint for a straight through processing project.  Sustainable savings in the order of $500K p.a. were identified during the opportunity analysis and estimated savings from those recommendations which have been implemented to date exceed $200K on an annualised basis.   Previous Next

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