Automation In Action: Eliminating the “Manual” Every Step of the Way

Jun 20, 2024 | Posted by Elevate

How to add thousands of employers and hundreds of thousands of accounts—without adding staff

There's a dirty little secret about consumer directed benefits administration—there's a LOT of manual work. From processing claims by hand to calculating funding requirements, this manual work can be time-consuming at best and cause significant delays and cost at worst...especially if there are errors introduced during the process.

Automation solves so many problems by eliminating the human factor—saving time, reducing costs, and eliminating errors while enabling unlimited scalability. At Elevate, we have built automation into all aspects of benefits administration.

How do we know it's possible to add so many accounts without boosting internal headcounts?
Because we've done it.

In this blog, we explore how automation impacts claims processing, participant notices, account funding, and more.

Claims processing

With claims automation, we use technology to handle repetitive tasks within the claims process and eliminate delays due to processing queues. In the past, a claim would be submitted online or via paper form and then routed to a human claims processor for review. This entire process can take days or up to weeks.

Not only was the process long and arduous, it could also be inconsistent. For example, let’s say a claims processor processes a claim and makes the correct determination to pay the claim. But the next time this claim is submitted, a different person – either a new employee, or one who simply makes a mistake – denies the claim. This inconsistency is extremely frustrating to participants...not to mention time-consuming. However, with automation, inconsistency is no longer a concern.

Elevate’s automation cuts the process to minutes and provides consistent quality every single time.

From the very first step, data entry is automated for participants by using AI to scan the documentation and fill in the required information. This can drastically cut down on manual work for the account admin, all while reducing typos and human error. The claim request itself is also automatically verified at this point of submission. AI verifies the submitted documents and claim details against the IRS-required information and plan rules and can issue accurate approval on the spot.

90% of claims can be approved instantly. But what if the claim information is not approved upon submission? Check out the Participant notifications section below.

With automation, there is no longer the need for a human to review, process, and adjudicate claims. Not only does automation reduce the buildup in a claims processor’s queue, it also leads to faster payments and more consistent rulings on claim eligibility. Perhaps most importantly, it eliminates the need for account administrators to hire more claims processors as your account base grows.

Automation eliminates the need to hire more workers as your account base grows.

Participant notifications

With legacy platforms, if a claim submission contained a mistake—or if the documentation was insufficient—the account administrator would have to notify and coach the participant on how to fix the issue, which may take days (or weeks!) to communicate and resolve. This slows down the claims processor queue with rework tasks.

When you introduce automatic coaching—powered by Elevate’s AI—there’s no need for human intervention. The automatic coach immediately provides participants with feedback on their submissions and offers guidance to correct any missing information. This means there’s no backlog, missed messages, or waiting for postal mail. It happens in the moment.

Here's how it works:

  • Real-time guidance: As participants submit claims, the automatic coach identifies any potential errors or missing information.
  • Step-by-step support: The system offers clear instructions and prompts, guiding users to fill out forms correctly and provide the necessary documentation.
  • Instant resolution: No need for back-and-forth communication or waiting for responses. Issues are addressed in the moment, preventing delays and creating a smoother claims journey.

By eliminating the need for manual intervention to address common errors, claims are processed faster. Automatic guidance minimizes mistakes during claim submission, leading to a more efficient process overall. Plus, because processors are freed from mundane tasks, account administrators are able to add clients without adding additional staff.  

“Before our AI coaching, about 12% of our reimbursement requests would get returned to the participants asking for better documentation,” said Brian Strom, co-founder and CTO of Elevate. “With our AI coaching, less than 2% are returned.”

Funding and contributions

At Elevate, we understand the importance of transferring account funding and contributions quickly and reliably. Delays and errors can create unnecessary stress for employees, employers, and administrators alike, which is why we've implemented innovative automation solutions throughout the funding process.

Traditionally, funding notional accounts (like FSAs and HRAs) and replenishing the minimum required amounts involved a lot of manual work, like verifying bank accounts and initiating transfers, and the work increases if there is ever an ACH error. Similarly, HSA contributions require special handling as accountholders go through the Customer Identification Program (CIP) process. Any errors in either process can lead to delays in participants receiving money needed to pay for health care needs, which also means more complaints back to the administrator. But with Elevate's automated funding system, this isn’t an issue.

Our system handles the tedious aspects of funding, freeing admins from manual processes while minimizing errors.

  • Calculations made easy: Funding amounts are automatically calculated, eliminating any room for human error. If any funding issues arise, such as a rejected bank account or wrong bank information, those errors are automatically routed through a defined path for quick (and also automated!) resolution.
  • Notifications in real-time: Client notifications are automatically initiated when funds move or if an error occurs, keeping everyone in the loop and reducing calls and questions to the administrator.
  • Funds move automatically: Pre-fund and replenishment from client accounts is completely automated, allowing for faster turnaround and preventing unnecessary delays.
  • Intelligent reporting: Real-time reporting allows you to see where accounts are in the funding and contribution process, so administrators are equipped to answer any questions or concerns that arise.
  • Exception handling: We’ve automated the unhappy paths as well. If an ACH payment is rejected for any reason, we trigger automated steps to notify, reconcile, retry, and resolve (both ultimate success and failure) with no intervention from Elevate or our partners.

Data files and transfers

Automation also extends to data transfers through our comprehensive API functionality, which allows for a real-time, seamless transfer of client data from our partners’ systems to ours. Say goodbye to flat files, file processing, batch processing, manual steps, and a limited set of APIs. At Elevate, every data interaction flows through APIs, which means fewer humans are needed to transmit data as your program scales up.

This fast, secure data transfer also simplifies client onboarding—allowing our partners to scale quickly and grow their business. Historically, with legacy platforms, onboarding a new client meant ticket queues, file transfers, customization fees, or limited plan customizations. But with Elevate, full API functionality makes plan setups and renewals, account funding, and employee enrollment as simple as entering data into your own system. This means account administrators are able to redirect headcounts to more strategic projects and reduce costs.

Automation equals partner scalability

At Elevate, we’ve built the power of automation into our platform to deliver a faster, more innovative solution than anyone else on the market...and our partners reap the benefits. Automation empowers TPAs, health plans, financial institutions, and benefits administrators to be more nimble by reducing manual work and human-related errors at every point in the administrative process—freeing them up to focus on growing their business at scale.

If you’re ready to learn more about moving faster than the competition and creating a better experience for your customers, request a demo today.

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