Company Achieves Astronomical Productivity Gains by Implementing PilotFish

A Revenue Cycle Solutions company’s growth was being stifled by cumbersome manual processes. Learn how the client leveraged PilotFish to initiate automation to introduce a tenfold improvement in capacity in one area and achieve a 360% increase in productivity in their claims processing process – paving the way for dramatic growth in their business.

THE CLIENT

The client is a well-established clinical laboratory billing and collection company serving companies nationwide. The organization offers cloud-based solutions which enable their client laboratories to maximize profitability through optimization of the revenue cycle and reimbursement process. The client has had (and continues to enjoy) significant commercial interest in its services. However, many of its critical business processes remained manual. This intense requirement on human resources threatened to put a cap on their growth, due to an inability to keep up with demand. 

THE CHALLENGE

The client receives a deluge of laboratory data from its customer base on a daily basis, representing all of the various tests for which their clients are in the process of seeking reimbursement. Before the implementation of PilotFish, this process was tedious, manual and expensive. The client’s billing staff was required to manually log on to each client laboratory’s system, each with a unique user interface and credentials, to access the physician’s initial requisition for the lab services in question. Other times, the orders were scanned by the laboratory and manually uploaded to a server as a PDF for the client’s staff to manually download and review. Often, large batches of orders would need to be painstakingly sorted and filtered by patient. In all cases, the billing staff was required to manually rekey much of the information on the human-readable requisition forms into our client’s internal system.

This process consumed our client’s highly trained staff with repetitive, error-prone tasks that limited their bandwidth. In many cases, the inefficiencies also impacted their end clients who were also consuming unnecessary time scanning and uploading lab requisition forms. Our client had new customers anxious to take advantage of their services but faced a data entry bottleneck that was handicapping their staff and undermining their growth. They recognized the clear business case for automation and after researching vendors identified PilotFish as their preferred partner in realizing a solution.

THE SOLUTION

The client selected PilotFish – identifying the eiConsole for Healthcare and eiPlatform Integration Engine Solution as a means of achieving rapid, repeatable automation of their laboratory onboarding and servicing workflow. Most, if not all, of their end client laboratories were using systems that were already capable of sending orders in an HL7 v2.x DFT (“Detailed Financial Transaction”) message format. So rather than dealing with humanly readable requisitions, the client began requesting that the laboratories send the orders in that machine-readable format. The DFT message is readily consumed by the PilotFish eiPlatform product, which includes a “lenient” HL7 parser that converts virtually any HL7-like message into XML without complex configuration. From there, the same information that skilled staff was previously responsible for rekeying could now be automatically fed to various downstream systems instantly – without effort or error.

When the client first selected PilotFish, it was submitting claims through a third party, cloud-based claims management platform. This platform exposed a JSON API that could be used to submit claim information. During the course of our client’s training on the eiConsole IDE, a set of PilotFish interfaces was configured to integrate with this product. Each DFT message received from a client lab was converted into a set of carefully-orchestrated API calls required to authenticate and submit data to this service. Shortly after the initial implementation, the client decided to migrate from this cloud-based offering to a self-hosted claims management software package. Rather than exposing an API for integration, this software sits atop a SQL Server database with which the client would directly integrate. In a matter of days, the client was able to configure new interfaces in the eiConsole, capable of consuming the same HL7 2.x DFT messages, but now converting them to “SQLXML”. SQLXML is a simple syntax that the PilotFish eiPlatform interprets to issue a series of SQL queries, inserts and updates that are compatible with virtually any relational database.

By decoupling interface logic from their core application with the eiPlatform, the conversion between claims processing systems was seamless. The transition was transparent to their business partners who experienced no interruption in the processing of their claims records. The client has further configured interfaces to process binary image attachments that are embedded within HL7 messages as Base 64-encoded strings. As labs transmit results for various patients to the client, a PilotFish interface is used to identify and extract imaged reports, decode them to their native binary representation and save them to disk for archival and review in the desired PDF format.

The client received the PilotFish-recommended formal 4-day face-to-face training program, during which a trainer presented a series of relevant training modules, hand-picked from the customizable PilotFish curriculum. These sessions included a combination of explanatory sessions, slides and demonstrations along with hands-on laboratory-style exercises for the participants. The training was supplemented with a mentorship period during which PilotFish worked collaboratively with the client to develop and bring the aforementioned initial interfaces to production.

In the nine months since the initial implementation of the PilotFish product suite, the client has gone on to implement ten new interfaces with laboratory trading partners – with virtually no additional assistance from PilotFish professional services staff. The client has become so comfortable with the tools that they can configure a new interface, including brand new data transformations, inside a single calendar day (as opposed to the two weeks it previously took).

The client has begun to process not only HL7 messages from laboratories but remittance files provided by the claims clearinghouse in HIPAA-compliant EDI 820 Transactions. The flexibility and consistency of the PilotFish platform have allowed them to use the same “automated interface assembly line” approach to consume these transmissions as they had previously implemented for the labs, despite the fact that the remittance data arrives as X12 EDI rather than HL7 2.x.

As remittance messages are downloaded from the clearinghouse, they are consumed by the PilotFish eiPlatform interface engine and parsed using the “EDI Transformation Module” (one of the many data formats supported out-of-the-box). Identifying information in each transaction is used to associate the remittance information with the appropriate claim record in the client’s database and to update that record with relevant payment status and details.

THE BENEFITS

Before the implementation of PilotFish, the client previously had a staff of seven individuals whose sole responsibility was the process of manual claim data entry. Today, those individuals have been reassigned to more valuable activities, effectively saving hundreds of thousands of dollars in cost.

The client is able to realize new business opportunities faster. Prior to implementing PilotFish, the average implementation timeline was approximately 2 weeks. This has been reduced by 90% to an average of under 1 day.

After analysis, the client determined that by using PilotFish to enter information associated with a claim and process it, end-to-end takes 7 minutes. Previously, before PilotFish, that same claim took “on average” 25 minutes before it was fully billable which is a 360% improvement.

As a transactional business, the more rapidly the client can bring a new laboratory customer on board and the more efficiently their claims can be processed – the more revenue is generated. PilotFish has fundamentally transformed both processes, delivering marked improvements in operational efficiency and a resulting quantifiable impact on the organization’s revenue and profitability.

THE FUTURE STATE

The client anticipates continued growth. Having proven that PilotFish can streamline the process of ingesting data from laboratory clients, they can remove data entry overhead as a governor on client onboarding and can begin to accept and implement new clients at an accelerated rate.

The client also looks to the future armed with PilotFish tools as well as the experience required to automate and streamline many additional areas of their business. In the short term, the client anticipates implementing additional automation of the processes used to transfer data between themselves and their claims clearinghouse. While the creation and consumption of these files have largely been automated, the mechanics of transferring them remains on the immediate “to do” list.

Longer term, the client has plans to expand the universe of data elements that they receive from their laboratory clients to improve their service offering. Armed with the PilotFish eiConsole for Healthcare IDE, they are already in a position to receive that expanded dataset in any format and via any connectivity protocol. The simple point, click, drag & drop configuration of the interface assembly line allows the client to offer unparalleled flexibility to their clients in support of this initiative.

HL7 is the registered trademark of Health Level Seven International.
X12, chartered by the American National Standards Institute for more than 35 years, develops and maintains EDI standards and XML schemas.