Intelligent Replication

According to FCG, as many as 20 percent to 40 percent of all claims fall out of the auto adjudication process and become suspended claims pends, costing insurers as much as $2 to $5 per claim.

This is a product that replicates what people do," says Doug Dietzman, delivery service lead for the business process automation group of First Consulting Group (FCG; Long Beach, Calif.), of the company's customizable, hosted solution for pended claims automation. According to FCG, as many as 20 percent to 40 percent of all claims fall out of the auto adjudication process and become suspended claims pends, costing insurers as much as $2 to $5 per claim. "This pended claims problem applies across the board for insurers, and it is a good place for us to provide savings for our clients," Dietzman says.

FirstPAS is a part of FCG's First Ops composite application suite. It is designed to solve claims pends by documenting the detailed steps and data associated with resolving targeted pends and configuring that same data and logic into the custom solution toolset, which is hosted in FCG's Nashville data center. The functionality is obtained through a combination of FCG's domain expertise and business partner Clear Technologies' (Westminster, Colo.) business process automation tool, Tranzax, which is targeted at "roll replication, creating a virtual worker," according to Dietzman.

According to FCG, health plans typically can expect to recoup the upfront investment in 60 days of production operation. "We base our fee on what we successfully automate and deliver," says Dietzman.