What Successful Payers Automate in Facets and QNXT

MaryBeth Folger News

Another Cognizant Healthcare Conference is under our belts. Though HCC 2020 looked a bit different than other years, we nonetheless set records on attendance and engagement as we all joined together safely from home.

Aaron Straus, HPA’s healthcare product manager, walked attendees through a comprehensive overview of common best practices for health plans automating in Facets® and QNXT™.

Straus introduced HPA, the leading RPA-as-a-Service provider for payers seeking secure and reliable automation solutions. Viewers learned about an exciting new development: the HPA Robot Marketplace featuring pre-built robots for Facets and QNXT that will accelerate implementations. Marketplace robots will cover all versions of Facets and QNXT, with future robots planned for QicLink as well.

“As TriZetto’s native RPA solution, we provide rapid implementation that can be used short term or long term to help drive more value for the business,” said Straus. “HPA clients regularly see a marked improvement in their auto-adjudication rates, as well as an average cost savings of 65% compared to manual processing.”

While there are opportunities for automation across the payer business, the most common areas are: Claims, PDM, Enrollment, Billing, Configuration, Customer Service, and Utilization Management. Claims is the most popular choice for automation by far, accounting for 89% of HPA’s payer robots. Within the Claims department, robots are processing manual pricing, adjustments, prior authorization, COB, provider matching, duplicates, member validation, timely filing, and utility robots to handle small, specific tasks that examiners perform repeatedly.

“Claims are always coming in, and they have to go back out. Your ability to process those claims on time is hugely important for plans to keep member satisfaction high, provider relations on good terms, and to gain new business in the future,” said Straus.

Please access the Cognizant Healthcare Conference portal to view additional sessions.