BlueCross BlueShield Affiliate · Healthcare · Chicago, IL · 16 weeks
Prior auth review cut from 4.2 days to 6 hours: a BlueCross BlueShield AI automation case study
A BlueCross BlueShield affiliate handled prior authorization requests manually, taking 4.2 days on average to review each. We developed an AI-driven triage and routing system, an RPA-style automation layer over the existing prior auth workflow, that cut review time to 6 hours and allowed the team to handle 18,000 more cases monthly without increasing headcount.
Challenge
The prior authorization team handled 42,000 requests monthly but averaged 4.2 days per review. Urgent requests required a 72-hour turnaround, but the team met that deadline only 61% of the time. Hiring more staff to fix this would have cost $2.8 million a year.
Outcome
We cut average review time from 4.2 days to 6 hours for cases handled by AI. Urgent requests hit a 97% on-time rate. Without adding staff, the team processed 18,000 more cases monthly, saving $2.8 million annually in labor. The AI triage managed 3,400 out of 5,000 cases completely on its own.
Results
- 4.2 days to 6 hrs Average review time
- $2.8M Annual headcount cost avoided
- 18,000 Additional cases per month
- 97 of 100 Urgent request compliance
We were falling short on compliance and thought our only choice was to bring in more people. Thinklytics built an AI system that helped us handle 97 out of 100 compliance cases without hiring anyone new.