Abu Dhabi Health Services Company (SEHA)

SEHA optimizes insurance claims - Enhancing the revenue cycle billing platform

Abu Dhabi Health Services Company (SEHA) has leveraged its partnership with Cerner in UAE to optimize and customize the revenue cycle platform billing tool to maximize outcomes.

Before the optimization

Prior to COVID-19, SEHA had a billing system that was capped by the number of insurance claims it was able to generate in a 24-hour period. To increase efficiencies internally, SEHA’s leadership team set out to enhance their infrastructure and prioritize system resources for clinical users. They also saw technical solution limitations due to SEHA’s payer mix in terms of having a high number of patients enrolled with the same insurance company.

After the pandemic hit UAE, SEHA took a leading role in the country’s pandemic response for patient treatment, as well as testing, screening and eventually vaccination services. Due to increased demand, clinical users were creating more encounters on the system than usual, translating to additional claims to generate with fewer resources available.

Objectives

• Grow the system capabilities to generate 125,000 insurance claims per day, using the same infrastructure and number of FTEs.
• Enhance and adapt the billing platform to ensure better outcomes.
• Adjust to SEHA’s increasing claim volume and revenue needs during COVID-19.

Developing the enhancements to the billing platform

Using a joint effort between Cerner Application Managed Services (AMS) and the SEHA revenue cycle management IT team, SEHA was able to develop the following enhancements to achieve the desired results, resulting in increased system throughput:

• Process / backend script automation: The scripting technique to group data more intelligently allowed the system to qualify more claim jobs in more parallel threads.
• Parallel processing: This enabled more claims to be generated simultaneously in non-peak user times, allowing for a better diversion of system resources to generate insurance claims when there were less clinical users on the system.
• Intelligent load balancing: A predictive algorithm was devised to allow for better control of claim volume through a single thread, increasing reliability of claim delivery.

Implementation

The implementation was phased, starting in November 2020 and was fully operational by March 2021.

Value achieved

This has enabled SEHA to meet the Department of Health’s requirements on claim submission timelines. Together, the team was able to optimize the existing Cerner Patient Accounting platform, allowing for its technical footprint to cope with the increased claim demands created by the spike in patient activity during the pandemic.

This support ensured that deadlines from SEHA’s payers to submit claims were able to be met. This resulted in the streamlining of SEHA’s revenue and cashflow management at a critical time.

Results summary

• Double the number of claims using the same number of resources
• Vital support for SEHA’s financial challenges due to their critical role in the COVID-19 response
• Reduction in process failures in claims
• More efficient use of system resources
• Reduction in average cost to claim
• Increased cashflow

COVID-19 resulted in an exponential increase of more than 200% in revenue cycle transactional volumes. In addition, numerous changes were introduced by the regulator which necessitated significant changes in contract management, billing, clinical documentation and capturing of patient demographics. The ability of Cerner to rapidly implement innovative, efficient and flexible solutions in a time bound manner helped SEHA navigate the challenges.

- Saji Pazhedath VasudevanAbu Dhabi Health Services Company - SEHA