Case Study: RELI Group

New generic platform allows for many use cases with large-scale reusability

The Business

RELI Group leverages deep industry knowledge, relevant experience and subject matter expertise to meet the evolving need for health care solutions, and deliver true innovation. With a team of experienced researchers and subject matter experts, RELI Group is a trusted partner of the US Federal Government and provides integral support to CMS through medical record review expertise, essential research support, and optimized PMO practice with services that fight fraud, waste, and abuse while ensuring a high quality of care for all Americas.

The Challenge

Due to time pressure and high demand for technological solutions and service for federal, commercial, and non-profit organizations, RELI Group needed to improve efficiency by automating processes and streamlining operations based on a single platform to provide the following capabilities:

  • Allows for many customer use cases
  • Supports the health care sector in many aspects of its billing, quality and medical record review and other workflows.
  • Is adaptable to the many regulatory and legislative changes in healthcare sector that happen daily
  • Provides advanced capture management, correspondence and end-to-end ADF-automation in one
  • Allows for fast time-to-market through agile/low-code development

The Solution

In only 3 months from development to production RELI Group built the new RELI-Ability platform with simplified integration and large-scale reusability on top of the Papyrus Communication and Process Platform and InterOPX Software for the evaluation of medical data.

RELI-Ability Platform Solutions

Three new solutions are currently available for use with more to come:

  • Medical Review Accuracy Contractor that reviews the accuracy of contractor claims for CMS using medical record from providers
  • Clinical Survey – General survey solution to provide statistical information on specific parameters for treatment of diseases
  • Comparative Billing Report (CBR) – Omni-channel communication to providers

The solutions are currently in use at RELI Group and can be configured and deployed to RELI Group customers as one application in one domain or multiple applications in one domain in the model the customer prefers – Google or other cloud environments, ‘on-premise’, or in other ways that suit the customer’s needs best.

Just-in-time Communication

RELI-Ability seamlessly integrates with electronic healthcare record systems to gather and capture data and removes the need for mailing, scanning or faxing claims and medical records. This reduces the burden on the provider community and other stakeholders, eliminating their security and privacy concerns. The platform puts the user at the center of the process and empowers users to apply their expertise and judgment, supported with direct access to the complete incoming and outgoing content, flexible document creation and delivery capabilities, as well as full support for handling various types of documents and information. All existing inbound and outbound communication channels (print, e-mail, fax, Web, HER-HL7 and FHIR, SMS, social media and mobile are fully supported.

Just-in-time Case Review

User interfaces and review screens are of special importance to medical users and are organized in a way that allows a highly specialized labor force to focus solely on evaluation and work in a most efficient way. Provided with the complete patient information and results of different reviews and WYSIWYG document previews, reviewers can easily read and analyze documents, enter the rationale for the review results and use the integrated access to medical libraries/references with the legislation from Congress for different sections that are relevant for the review at hand.

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Full Auditability

The platform provides full auditability – the complete information on everything that was being touched by anyone is securely stored in a case – if there is any doubt, questions or objections, the case can be re-opened and the information on who touched what when and what decision was being made provided as required.

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Business Benefits

Today, the enviaM staff produces the required business documents by assembling them as multilingual building blocks in the CCM Solution, which provides a centralized and consolidated location of content.

Just-in Case Review:

  • All records uploaded & linked into a single view for review
  • Reduction in review time (from 1,250 cases/month to 3,000 cases/month)
  • Improved accuracy of reviews
  • Increased auditability
  • Real-time visibility as to status

Overall:

  • Factor 20 Reduction in labor hours (from $720,000/year to $36,000/year)
  • Improved profits from existing contracts
  • New revenue streams