Executive Summary:
HiLabs' Roster Automation solution has achieved significant success with a national blue plan with touchless processing of 100,000 rosters from providers across the nation. The impact went far beyond simply standardizing rosters, which provides only 25% of the total value across the process.
To provide full value, a roster automation solution must: standardize rosters, add complex networks and pricing rules, provide balance and controls, and provide direct feedback to providers, all without any human involvement. Through the integration of AI-driven technology and a digital rules engine capable of managing millions of business rules, HiLabs' solution lets health plans achieve true, end-to-end automation of roster management.
Need for Roster Automation:
The urgent need for roster automation arises from the inefficiencies from current manual processes in health plans that are plagued by errors, time-consuming tasks, and high costs. Traditional methods, like ETL (extract, transform, and load) are insufficient for comprehensive automation.
The 2021 CAA's No Surprises Act mandates a strict 48-hour turnaround time (TAT) for provider directory updates, highlighting the need for rapid roster automation. While some focus only on roster standardization, HiLabs' solution excels by automating the entire process—from intake and standardization to updating core provider databases—without manual intervention. This approach ensures transparency and feedback to providers, empowering health plans to optimize efficiency and comply seamlessly with regulatory requirements.
HiLabs Rosters Automation Features:
AI-Based Computer Vision Extractor (CVE):
HiLabs' AI-based extractor parses rosters of any format, providing roster-agnostic functionality, while streamlining workflows and enhancing operational efficiency.
AI-Powered Standardization:
HiLabs' AI interprets rosters as a seasoned subject matter expert would, analyzing headers and file structure for precise standardization, enhancing the efficiency of health plan operations.
Normalization:
The solution manages diverse data in provider rosters, ensuring seamless normalization and integration for accurate PDM updates.
Digital Rules Engine
HiLabs’ intuitive Digital Rules Engine empowers business users to quickly set new contracting rules and onboard providers without technical expertise, accelerating a historically time-consuming process.
Comprehensive Validations at Time of Intake:
The roster automation solution features comprehensive validation checks to prevent erroneous data transmission. These checks ensure data quality, integrity, and completeness. Customizable for specific credentialing requirements, the solution enhances regulatory compliance, particularly for Medicaid, improving administrative efficiency and member access to healthcare services.
State-of-the-Art Reconciliation:
The system offers live roster editing and seamless re-submission, eliminating manual processes. This enhances efficiency, accuracy, and transparency, alongside comprehensive reporting and reduced fallouts in roster management.
Operationalizing the Roster Automation Solution
HiLabs' Roster Automation solution offers comprehensive support, ensuring seamless integration into existing workflows. With robust upstream integrations, it provides flexibility for providers to submit rosters in any format. Integrations with provider data management (PDM) and ticketing systems streamline communication and data exchange for a complete end-to-end solution. HiLabs' experts manages all integrations, guaranteeing compatibility and optimal performance, freeing health plans from technical complexities.
The Next Frontier: Health Plan Roster Generation and “Provider-Less” Data Updates
Health plans have always relied on providers rosters (and other provider update channels) to keep provider data up to date. However, given the administrative challenges for both plans and providers with the status quo, the HiLabs team has developed technology to create files to update provider information directly from providers’ consumer-facing channels. We work with plans to consume that data and compare it against plans’ existing databases. HiLabs then proactively updates their data and sends the changes to providers for reference and/or sign off. This proactive approach can greatly reduce administrative burden while improving data quality.
Conclusions
HiLabs' Roster Automation transcends conventional API-based roster standardization solutions, presenting a synergistic blend of AI technology and comprehensive business rule enhancements that delivers optimal value to health plans in an end-to-end fashion. The company’s focus is to help plans achieve true data automation and enable transparent reporting, aligning with the evolving landscape of healthcare regulations such as CAA 2021.
In summary, AI solutions transform human teams by automating routine tasks, freeing up valuable time for innovation and strategic initiatives. This shift from manual, administrative tasks to more high-value activities empowers health plan teams to focus on enhancing patient care, driving operational efficiency, and fostering innovation across the organization.
For more information, please visit hilabs.com or contact info@hilabs.com