Medical billing errors and gaps in claims processing cost Property and Casualty (P&C) insurers and Third-party Administrators (TPAs) millions of dollars every year. They battle revenue loss, high operating costs and poor customer experience.

WNS enables you to drive a total transformation across all areas of your Medical Bill Review (MBR) operations.

 

How We Do It

  • The right combination of platforms, people and process

  • Plug-and-play operating model gets you off the ground faster

  • Hyperautomation-led efficiency passed on to your MBR operations

  • Best-in-class processing accuracy

  • Driving insights locked in transactions to enhance experience and outdo the competition

  • Deploying the most comprehensive MBR framework – “R.A.D.A.R.”

 

What to Expect

WNS Medical Bill Review Services

  • Up to 45% lower Total Cost of Operations (TCO)

  • 99.5% bill accuracy in field-level data

  • 99.5% coding accuracy

  • 30% higher Net Promoter Score (NPS)

  • <48-hour Turnaround Time (TAT)

Guaranteed accuracy, cost-efficiency and an unmatched commercial proposition mark WNS’ MBR services. We leverage best-in-class technology and in-house domain talent to deliver lean MBR operations with superior outcomes.

 

MBR Transformation with the WNS R.A.D.A.R. Framework

Re-invent processes. Accelerate Automation. Domain-led. Analytics-driven. Re-imagined experience.

Drives best-in-class MBR services across front-end activities (mailroom operations, data capture), bill and code review, and medical management (clinical review) areas – underpinned by highly trained quality professionals, technology solutions and process re-engineering for delivery excellence.

 

Our End-to-End Service Delivery

 

Technologies that underpin our offering

  • Fee schedule and Usual, Customary and Reasonable (UCR) application

  • Bill review platform with Optical Character Recognition (OCR)

  • AI / ML rule-based workflow management

  • Online approval and real-time web portal

  • Data integration and electronic interface

  • Web-based management reporting

Proprietary solutions

  • Skense - A cognitive data capture and contextualization platform

  • WNS Expirius - A framework for a whole range of interaction and CX analytics solutions

  • TRACKBOX - An intelligent workflow solution (intake, coding, review)

  • Ethan – A CRM-integrated automated user support chatbot

Technologies that underpin our offering

  • Fee schedule and Usual, Customary and Reasonable (UCR) application

  • Bill review platform with Optical Character Recognition (OCR)

  • AI / ML rule-based workflow management

  • Online approval and real-time web portal

  • Data integration and electronic interface

  • Web-based management reporting

Proprietary solutions

  • Skense - A cognitive data capture and contextualization platform

  • WNS Expirius - A framework for a whole range of interaction and CX analytics solutions

  • TRACKBOX - An intelligent workflow solution (intake, coding, review)

  • Ethan – A CRM-integrated automated user support chatbot

 

WNS R.A.D.A.R. Impact Stories

Client: Leading US workers’ compensation service provider

Challenges: Reconciliation of images received prior to processing, high-volume processing on certain days, high processing cost for regulatory requirements

Solutions: OCR tool along with key field validation, an online reporting system for bills processed and a real-time view of work progress to the client, and a flexible staffing model to manage fluctuating volumes

Outcomes: 32% improvement in operational efficiency, 50% volatile volumes handled, claims TAT reduced from 3 days to 1 day

 

Client: US-based platform provider for medical liability claims for auto casualty

Challenges: Multiple end-clients with unique processing guidelines, severe financial penalties associated with provider claims for incomplete and inaccurate processing and poor financial accuracy

Solution: Seamless transition of 30+ end clients through EnABLE, a WNS in-house transition methodology, a digital workflow solution to standardize and shorten the onboarding time for new clients, an audit to improve financial accuracy and AI / ML tools as aids for nurse reviews

Outcomes: 35% operational efficiencies and 99.75% financial accuracy

 
 

Why WNS?

  • 20+ years of experience, serving the largest TPAs in the P&C sector

  • Deep understanding of compliance standards across all 50 states in the US

  • 30 Mn+ auto casualty / BI and workers’ compensation transactions handled in a year

  • 6.5 Mn+ first-party and 5.5 Mn+ third-party transactions handled

  • 60% of MBR markets serviced

  • Expertise across top 5 industry-leading platforms for both workers’ compensation and auto injury

  • 1900+ FTEs handling injury management processes

  • ~1 Mn nurse reviews performed annually