Healthcare Cashless Claims Automation & SLA Optimization
Modernizing adjudication triage from 48-hour delays to 2.4-hour instant pre-authorizations.
The Problem / Challenge
- •Hospital billing counters suffered from high patient anxiety due to unpredictable 36 to 48-hour cashless claim approvals.
- •Over 22% of claims were rejected due to minor paperwork typos, missing room-rent cap deductions, or obscure exclusion clauses.
- •Operations teams were drowning in fragmented email threads, manual PDF scannings, and unorganized escalation queues.
Bhaway's Strategic Approach
- Designed a deterministic validation engine matching doctor diagnostic codes (ICD-10) directly against policy coverage tables.
- Introduced automated optical character recognition (OCR) with human-in-the-loop review for edge cases.
- Created an interactive policy comparison & claims portal providing users and coordinators with real-time step-by-step status.
- Implemented proactive hospital network routing to ensure patients selected 100% cashless partner facilities.
Bhaway's methodical breakdown of our claim bottlenecks saved our team hundreds of hours and restored trust with our patients at their most vulnerable moments.”