Since payer contact centers experience huge call volumes, there are wait times of as high as 20-60 mins. Also 5-10% of calls get dropped during the hold times and BPO agents have start all over again. Hence this process of calling payer contact center and checking claim status is outsources to BPO companies. This is a big pain point of BPO companies as their agent are spending time on a completely non-value adding activity.
Another pain point is that, when the payer agent picks up the call, BPO agents check status of multiple claims on a single claim. Once the call is over, the BPO agents have to feed information into the internal system for each of the claims. This is referred as disposition and it takes 10-15 mins to make entries in the internal system and since this is a manual process, it often has errors. These errors if identified by the RCM companies can lead to penalties.
At this roundtable, we will bring together industry leaders, experts, and professionals to explore the challenges faced in RCM processes and the innovative solutions that are reshaping the healthcare financial landscape.
Presenting Partner
Engagely is a leading No-code CX automation platform augmented with Microsoft Azure Open AI, Generative AI, and Voice AI technology. From BFSI to Healthcare to Pharma, Engagely empowers enterprises across industries by automating their customer support and CX. Engagely helps BPOs upgrade their manual, resource intensive operations with efficient contact center software- all this with minimal setup time, enterprise-grade security, flexible deployment options and no additional IT overheads.
The ready-to-use industry specific pre-built AI models, real-time analytics, multilingual support, omnichannel presence, and seamless integration capabilities help enterprises accelerate growth with improved efficiency by delivering exceptional experiences for customers and employees.
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Challenges with RCM Processes
The process for healthcare providers (hospitals) to get the payments from insurance companies (payer) is very complicated and takes time with a lot of queries back and forth between insurance companies and hospitals. This results in: