How might we eliminate the complexity of the coordination of benefits paramedical claims process?
The Current COB Experience Pain Points
What should this process look like in today's digital age?
How can policy holders have a more seamless process similar to dental claims?
Can policy holders submit data once and have the process automated between insurers?
To encapsulate these innovations, the team created a new digital platform called "Road Runner" focused on accelerating the APS process.
The solution, named Clowder by the project team, is focused on eliminating the need for plan members (who have multiple health coverages) to re-submit their paramedical claim to the second & subsequent insurers by using Blockchain hyperledger fabric technology. In addition, Clowder is a proof of concept for how we can leverage Blockchain technology within the insurance industry.
This MVP enables a customer to submit a single claim, and have it adjudicated by two insurance providers.
In theory, any number of insurance providers and customers may be added to the solution. This would allow, for example, a single claim to be adjudicated by more than two insurers.
Brings improved data quality through new digital tools
Shares an immutable record of the claim across multiple insurers
Simplifies claim process and identification of primary payer for policy holder
In this four-week sprint, the team aimed to design the minimum viable product (or MVP) to test with real customers.