{"id":17613,"date":"2025-05-26T11:19:01","date_gmt":"2025-05-26T09:19:01","guid":{"rendered":"https:\/\/newmediacreative.co.za\/afrocentric\/?p=17613"},"modified":"2025-06-25T11:38:09","modified_gmt":"2025-06-25T09:38:09","slug":"mission-impossible","status":"publish","type":"post","link":"https:\/\/newmediacreative.co.za\/afrocentric\/archives\/17613","title":{"rendered":"Mission (im)possible"},"content":{"rendered":"\t\t
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Medscheme has stepped up support for clients by automating mundane tasks so that skilled employees can spend more time supporting members. To achieve this, the team had to rise to the challenge of solving the impossible: inputting unstructured data for automation. <\/h5>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Medical scheme administrators and managed care companies are constantly seeking optimal ways to service their medical scheme clients.<\/p>

Beneficiaries of medical schemes typically only engage with their medical scheme in times of need, navigating complex benefit designs and funding rules at a time when they may also be in distress due to a medical emergency or diagnosis. At Medscheme, we support the members of our client Medical Schemes during these difficult times by coordinating their care and providing the necessary benefits.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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To achieve this effectively, and at scale, we faced the challenge of automating internal processes and removing mundane tasks so that our skilled staff could spend more time supporting our members. Our aim was not only to enhance care coordination efforts but also to reduce servicing times and the risk of errors, ultimately offering a more consistent service experience to all scheme members.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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\u00a0The automation journey <\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Medscheme’s journey to automation began over seven years ago with the introduction of Robotic Process Automation (RPA), designed to offload repetitive, manual tasks and free up skilled teams to provide support to members. Today, over 65 business processes are automated, with 100 bots now managing nearly 200,000 work items per month.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Data incoming <\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Considering that email is still the largest servicing channel with the most unstructured data, we had to either shift servicing to other channels where we could drive structured data inputs or find solutions to extract and structure the data we were receiving via email. Changing customer behaviour is no small undertaking, so while we enable self-servicing channels, we also cater to those who prefer to engage via traditional digital channels such as email.<\/p>

Hospital facilities use the web portal, where unstructured data is also received in the form of free text requests containing information related to changes in hospital events. These changes could include additional diagnosis codes, altered lengths of stay, levels of care, and billable items such as medicine and consumable NAPPI codes and service-related tariffs.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Extracting our data <\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Our solution focused on the email and web portal channels, aiming to achieve high levels of structured data extraction. Any \u201cdata in\u201d smart extraction solution should be portable across other servicing channels where unstructured data is received. Our solution is intended to ingest conversational and free text request content in the channel as well as the attachments included.<\/p>

The Medscheme Hyper-Automation team, in collaboration with AfroTech and Cogent, set about solving the problem by processing the unstructured data, interpreting it, and then standardising the inputs for process automation.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Challenge accepted <\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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We faced significant challenges during the automation process but these were addressed effectively through innovative solutions and an agile approach.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Use cases and outcomes: <\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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We\u2019ve identified three primary use cases for our automation efforts relating to pre-authorisation requests and\/or updates for renal dialysis, specialised radiology procedures and in-hospital physio services:<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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1. Automate the interpretation of free text requests received for new pre-authorisations or case updates<\/span><\/b><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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