A large provider of medical claims processing services needed a more efficient way to track and manage claims for over 150 medical clients. The organization sought to centralize the retrieval of medical claims stored in various data sources and streamline the management of open claims. To ensure consistency and scalability for future practices, a standardized process was imperative. By partnering with M2, the medical billing company implemented a tailored solution using Smartsheet Control Center. This solution automated claims processing, provided real-time performance tracking, and enabled seamless collaboration across locations. The result was improved operational efficiency, enhanced financial oversight, and a scalable platform to continue the company’s growth.
Client Challenges
Decentralized & Inefficient Claims Management
The company lacked a centralized system to manage medical claims across its 150+ clients, leading to:
- Claims data stored in multiple sources, making retrieval and tracking inefficient
- No standardized process for managing open claims, causing inconsistencies
- Limited visibility into claims performance, affecting oversight and decision-making
Lack of Standardized Tracking & Performance Metrics
Claims were managed inconsistently, which resulted in:
- Difficulty in tracking staff performance and ensuring claims were processed efficiently
- No real-time reporting to assess overall claims status and performance
- Inability to demonstrate return on investment (ROI) to clients
Manual, Time-Consuming Follow-Up Processes
The manual tracking of claims and follow-ups created inefficiencies, including:
- Staff struggling to identify and track invalid action responses for over 10,000 claims
- Lack of automation, leading to increased workload and processing delays
- No streamlined way to communicate and manage client onboarding and offboarding
M2's Customized Solutions & Implementation
Solution 1
Centralized Medical Claims Management System
M2 implemented Smartsheet Control Center to provide a centralized, automated system that transformed billing claims management. Key features included:
- Standardized template sets for all 150+ clients, ensuring consistency
- Automated claims processing workflows to track open/closed claims daily
- Real-time performance tracking dashboards to monitor claim status efficiently
Solution 2
Integrated Performance Tracking & ROI Reporting
To improve visibility and efficiency, we developed a real-time performance tracking system that:
- Automated staff performance monitoring, ensuring claims were processed effectively
- Created executive dashboards that rolled up key metrics across all clients
- Enabled ROI demonstration, providing clients with insights into claims efficiency
Solution 3
Automated Business Rules for Claims Follow-Up
To reduce manual effort and improve accuracy, we did the following:
- Configured business rules to track invalid action responses for over 10,000 claims
- Developed automated workflows that flagged claims requiring follow-up, reducing processing delays
- Enhanced collaboration tools, allowing staff to communicate on key claims topics seamlessly
Results Achieved
Optimized Claims Management & Increased Efficiency
- 100% centralized claims tracking, improving visibility and standardization across all clients
- Automated claims opening/closing processes, reducing manual work and errors
- Scalable solution, allowing for seamless onboarding of new practice locations
Improved Staff Performance Tracking & ROI Measurement
- Real-time dashboards provided immediate insights into claims processing efficiency
- Standardized performance tracking enabled measuring ROI for clients
- Enhanced decision-making capabilities, ensuring leadership could optimize resources
Enhanced Collaboration & Automated Compliance Monitoring
- Business rule automation significantly reduced manual follow-ups for over 10,000 claims
- Automated alerts and notifications, ensuring timely claim processing
- Improved communication tools, making onboarding and offboarding of clients seamless
Automate & Scale Your Operations with Confidence
Are you ready to eliminate inefficiencies, streamline workflows, and scale your operations seamlessly?
Automation is the key to unlocking greater productivity, real-time visibility, and cost savings—ensuring your business is equipped for growth. Contact M2 today to discover how our innovative solutions can optimize your operations, reduce manual work, and improve decision-making.
