Work Distribution

Work Distribution encompasses two approaches: manual selection, where resources choose tasks from assigned queues, and automated allocation, where a distribution engine intelligently assigns tasks using predefined rules. This system enhances flexibility and efficiency, catering to various work types and optimizing resource utilization.

Automation of work distribution is critical to assist healthcare in enhancing and refining everyday operations. Its primary objective is to optimize processes to ensure efficiency and seamless functionality. After records/documents are ingested via API or Service into the Queue(s), there are two basic ways of distributing them:

Manual Distribution based on Resource

Resources pick what they want to work on from any assigned work Queues. There are two variations, depending on whether the work is assigned to the OHB ( Over Head Bin – a repository of documents/records) or the personal work Queues. In the case of OHB, the work can be pulled into the work Queue and processed, whereas, in the case of personal work Queues, the work is assigned/routed by the manager/other user and can be accessed anytime for processing.

Automation Distribution based on Rules

The work in the Queues can be allocated, and the distribution engine will automatically make intelligent decisions for you!  The configured rules can be used strategically to group the work based on LOB, Claim Type, Aging, TAT, Priority, Pending Inventory, and Errors, which will set the stage for the system to accurately and efficiently assign work based on the user roles, expertise, and permissions of the resource(s). These groups saved as distribution rule sets can be easily modified as efficiency gains are reaped.

Target Management

Efficient target allocation is achieved by combining data-driven insights and AI techniques, catering to diverse resource levels. The process optimizes productivity goals by harnessing AI recommendations and collaborating with supervisors, managers, and experts. This holistic approach ensures precise target alignment with business objectives while upholding ethical standards. 

Target allocation is automated by utilizing data-driven insights and AI methodologies, InsightPro based on historical data, optimizing productivity goals to accommodate varying resource capacities and promoting collaborative alignment. This approach encompasses ethical considerations and holistically enhances overall performance.

Data-Driven Precision:

Refine productivity targets using AI and historical data, adapting them to diverse resource levels for optimized efficiency. Data insights enable precise goal-setting.

Customized Efficiency:

Tailor productivity goals based on resource tiers, utilizing AI insights for targeted improvements. Resource-specific targets enhance operational effectiveness.

Collaborative Alignment:

Combine AI suggestions with teamwork to assign precise targets that align with business goals. Collaborative input ensures goal relevance.

Ethical Empowerment:

Prioritize ethics in target optimization, creating a culture that balances productivity and well-being. Ethical considerations drive responsible goal-setting.

Transparent Accountability:

Justify targets transparently, aligning them with ethical principles and business values. Transparency fosters understanding and commitment.

Holistic Performance Strategy:

Merge AI insights and expertise for a comprehensive approach to target management that promotes ongoing improvement. The synergy of AI and human knowledge enhances strategic goal-setting.

Idle time and Break Tracking

Empower your workforce with a transformative time management approach through meticulous time allocation monitoring. Effortlessly categorize tasks as productive or non-productive activities, gaining valuable insights into resource utilization. Harness the potential of tailor-made suggestions to refine time management strategies, leading to optimized productivity across the board. This innovative solution fosters a culture of mindful time allocation and contributes to increased efficiency, driving sustainable success in organizational endeavors.

Elevate time utilization by implementing Idle Time and Break Tracking. This initiative allows managers to optimize resource allocation, customize time management strategies, and improve productivity. By strategically categorizing tasks and viewing InsightPRO’s personalized recommendations, managers can allocate resources effectively, enhance time management practices, and ultimately achieve higher productivity.

Strategic Time Allocation:

Efficiently monitor the team’s time distribution by categorizing tasks into productive and non-productive activities. This approach enables strategically allocating resources to tasks that align with process objectives, boosting overall productivity.

Tailored Time Management:

Receive personalized suggestions to refine time management practices based on historical patterns and task categorizations. This tailored guidance enhances efficiency, enabling the team to maximize their time.

Productivity Enhancement:

Implement improved time management strategies derived from task categorization and personalized recommendations. As the team adopts more efficient practices, productivity is heightened, contributing to accomplishing key goals.

Real-time Notifications

Experience a paradigm shift in operations with real-time notifications that offer immediate insights while processing. These notifications are backed by impactful indicators that demand swift attention, ensuring proactive process management. Displaying machine learning-based automatic notifications of the updated guidelines, Potential Error, KPI based thresholds while processing records help improve overall quality. This transformative approach yields enhanced visibility and control, ushering in a new era of effective operations management that drives lasting success.

Harness the power of real-time insights and alerts to revolutionize your operations. Embrace AI-powered notifications that provide instant process insights, significantly improving accuracy and process efficiency. By proactively addressing challenges, optimizing processes, and cultivating a culture of excellence, drive remarkable improvements throughout your processes.

Automated KPI Intelligence:

Revolutionize your operations with automated notifications empowered by advanced machine-learning techniques. These notifications update you on key performance indicator (KPI)–based thresholds during the review.

Automated Processing Alerts:

Receive alerts on Potential errors and new or enhanced guidelines to ensure superior data quality and prompt corrections or precautions for seamless operations. Stay at the forefront of superiority with these timely alerts, fostering a culture of continuous improvement and ensuring top-tier quality standards.

Block User

Elevate error control and user accountability with the advanced feature of blocking users. This capability restricts claim processing when errors exceed a predefined threshold. By enforcing quality standards and ensuring accurate processing, this functionality improves error management and streamlined operations, ultimately enhancing the overall quality of claims processing. …..See More

Efficient Error Control:

Enhance data integrity and precision with the User Blocking Feature. This robust tool prevents claim processing when error thresholds are exceeded, ensuring accuracy, quality, and proactive error management for smoother operations

User Blocking Feature:

The system offers a robust feature allowing administrators to block users temporarily, prohibiting them from processing claims once a defined error threshold is exceeded. This mechanism ensures data accuracy and compliance by preventing further claim handling until the issues are addressed.

Threshold-Based Error Control:

This functionality sets a defined error threshold that, when crossed, triggers the user-blocking action. Administrators can fine-tune this threshold to align with specific quality control standards, ensuring that claims with excessive errors are intercepted for rectification before further processing.

Data Integrity and Quality Assurance:

This feature upholds data integrity and supports quality assurance efforts by blocking users who exceed error thresholds. It prevents potentially erroneous or incomplete claims from progressing through the processing pipeline, safeguarding the accuracy and reliability of the claims database.

Proactive Error Management:

The user blocking feature promotes proactive error management by instantly identifying and addressing discrepancies. Once errors surpass the set threshold, the processing is halted, prompting quick corrective actions and minimizing the impact of flawed data on downstream processes, ultimately contributing to smoother operations and enhanced claim accuracy.

Check Run and Stop Loss

Experience enhanced processing efficiency with the innovative Check Run and Stop loss feature. The stop-loss functionality facilitates the distribution of priority groups to examiners. At the same time, Check run ensures holding the groups that need not be distributed precisely during check run days and times. These features optimize operations and ensure effective resource allocation, ultimately contributing to streamlined and efficient workflows.

Distribute holding groups to align with check run timing, prioritize critical loss issues, ensure timely task handling, and strategically allocate resources for enhanced operational efficiency and results.

Streamlined Examiner Distribution:

This unique feature facilitates the holding groups on specific days and times for distribution to examiners based on the timing of the check run. Examiners receive groups precisely when check run processing is completed, ensuring optimal efficiency and alignment between task and timing. This seamless synchronization ensures the right tasks are managed at the right time, improving overall productivity and responsiveness.

Prioritizing Top-Stop Losses:

The system prioritizes and distributes the top-stop loss-related claims to groups. Critical issues are promptly addressed by effectively managing and directing prioritized work to the examiner, minimizing potential losses and operational disruptions.

Strategic Resource Utilization:

By integrating this feature, resource allocation becomes more strategic. Examiners need not keep track of check runs during processing and can focus on high-priority and regular tasks, maximizing their efficiency and contributing to the process and operational effectiveness.

User Management

Streamline administrative tasks with manager/supervisor-configurable user and group settings. Eliminate change requests and manual adjustments by enabling seamless group establishment, user assignment, and access privilege definition. This intuitive system enhances administrative efficiency and empowers managers/supervisors with streamlined control.

Elevate User Control and Management:

Leverage InsightPRO’s robust user management capabilities. Empower managers and supervisors with streamlined configuration control, seamless group management, simplified user assignment, and precise access control. These features ensure efficient collaboration, aligned permissions, and enhanced data security.

Empowered Configuration Control:

InsightPro empowers managers and supervisors with user and group configuration capabilities, eliminating the cumbersome process of change requests or manual administrative adjustments. This dynamic feature enables effortless establishment and removal of groups, streamlined assignment of users to these groups, and precise definition of access privileges.

Seamless User Group Management:

Managers and supervisors gain seamless control over user groups, allowing them to establish, modify, or delete groups as needed. This level of control ensures that team structures and access permissions remain current and aligned with evolving operational requirements.

Simplified User Assignment:

Assigning users to specific groups becomes a hassle-free task within InsightPRO. Managers and supervisors can allocate team members to designated groups effortlessly, facilitating better collaboration, communication, and access to shared resources.

Precise Access Control:

The user management functionality continues beyond grouping. It extends to defining access privileges for each group. Managers and supervisors can fine-tune access rights to ensure team members have access to data, tools, and functionalities, enhancing security and efficiency.

Audit Trail

Efficiently track, record, and report workflow and process elements with accessible, detailed information. Uncover insights into participants, actions, timing, locations, and transactions, ensuring alignment and detecting deviations. Audit trails hold multifaceted roles, from regulatory compliance verification to continuous improvement and training support. By visualizing proper process execution, audit trails drive accountability, transparency, and operational excellence.

This robust feature provides a comprehensive view of tasks, actions, and participants, ensuring adherence, aiding regulatory compliance, and enhancing training for new employees.

Comprehensive Tracking and Reporting:

Access a robust audit trail feature that empowers you to comprehensively track, record, and report every facet associated with a specific workflow or business process. This comprehensive view offers insights into participants, actions, timestamps, locations, and transaction methods, ensuring transparency and accountability.

Insightful Alignment Verification:

Utilize the audit trail to gain in-depth insights into aligning tasks and actions within your workflows. By meticulously recording participants’ engagement, timing, and methods, you can verify task execution adherence and promptly identify any possible deviations.

Multi-Functional Purpose:

Audit trails serve various critical functions, including supporting regulatory audits to validate compliance with established standards. Furthermore, they facilitate ongoing improvement initiatives by providing a clear record of process execution, allowing you to analyze trends, identify bottlenecks, and implement refinements.

Training and Knowledge Enhancement:

This feature also plays a pivotal role in training and knowledge transfer. For new employees, audit trails visually demonstrate the correct execution of processes, aiding training by showcasing real-world task execution. This immersive approach ensures new team members can quickly grasp and adhere to established procedures, contributing to a smoother onboarding experience.