Case Study

Digitizing Reimbursement, and Reconciliation Process for Leading Insurance Group

Enhancing Michigan Personal Injury Protection (PIP) Insurer's Billing Efficiency: Rapid Digital Platform Revolutionizes Reimbursement and Reconciliation process with Michigan Catastrophic Claims Organization (MCCA).


Improve the efficiency and redesign the reimbursement and reconciliation process by creating a system that coups with rules mandated by Michigan State Catastrophic Claims Organization (MCCA).

The Billing team partnered with RNT to streamline the process of data collection for creation of Request for Reimbursement (RFR), Monitoring claims breach, Submission of RFRs and Reconciliation with MCCA over denied bills.

With the implementation of our application the average handling time required through the end-to-end process is reduced from 1.5 weeks to maximum 10 working hours.

Leading P&C Insurer’s Claims Billing Department in search of solution to meet the MCCA guidelines and improve the PIP billing process.
The transformation in the Michigan Personal Injury Protection (MI PIP) framework in terms of the requirements for Reimbursement are implemented by MCCA effective July 2021. The changes mandated by MCCA resulted all insurers in Michigan to review and, revamp the process that was in place for submitting reimbursement requests to MCCA. MCCA has introduced this change to pass data at a line-item level for rate/fee validation.

The Key Challenges Were:

arrowThe submission of Request for Reimbursement (RFRs) with seventy-one details on each bill rather than the previously existing bill level of seventeen fields.
arrowSubmissions of RFR reports via “XML” and “Web Services” instead of RFR submission via excel sheets.
arrowRetrieval of response from MCCA on the submitted RFRs.
arrowCreation of mechanism to calculate the accurate $ amounts requested, received, pending, and accepted as variance at each bill, RFR, and claim.
The main reason for initiating this project was to determine the options available for developing a solution that will satisfy the MCCA’s requirements with a streamlined and automated workflow.
response to these challenges, the Insurer collaboratively engaged with RNT to leverage the best mix of technology and meet the MCCA amends by improving the process as well as user experience hand in hand.
Introducing a semi-automated web application with custom built rules for data validation and data communication with MCCA
We developed an application to meet business expectations by complying the MCCA guidelines and automating the repetitive tedious tasks. The key requirements kept in mind while designing the solution for Michigan PIP process are:
Daily Tracking for Claims Retention Breach

The application checks all claims to identify the retention breach. When the claim breach is detected, it is listed on application for biller’s validation and approval for initiation of RFR creation process

Request for Reimbursement Creation and Submission

RFR Creation The application creates the requests for reimbursement forms for all breached and approved claims based on rules defined by MCCA. The mandatory validations by MCCA are checked and applied on the data in the RFR. Users are privileged to edit certain fields in the bills to fix the data per MCCA requirements.

RFR Submission To resubmit a RFR users must click a “Submit” button and rest can be taken care of by the application. The application is integrated with various webservices offered by MCCA systems which are used to automate the process of data transfer for RFR submission.

Tracking MCCA responses

The application tracks the status of requested reimbursements using MCCA Webservices on a daily basis. Denied reimbursements are listed for user’s review.


The users are presented with a list of denied bills and the option to either resubmit the denied bills with changes allowed by MCCA or accept the amount variance.

Reimbursements Tracking

The application continuously monitors and maintains the details of each claim, RFR, and bill for the amounts requested, received, pending, and variances accepted.


The dashboard module of the application facilitates summarized view of financial figure associated with reimbursement and Reconciliation process.

Business Impact
With the deployment of this application enabled the business users to seamlessly submit and track the Reimbursement and Resubmission request, and live reporting on the financials of each claim.
The processes of monitoring claim retention breaches and RFR creations are 100% automated.
The billing team saves upto 4 days on initial RFR submissions and upto 2 days on cyclic RFR submissions.
The information in the RFRs and financials details of claims are sourced from the respective systems leaving no rooms for human errors.
No more manually tracking the submissions and reconciliations neither the financials of claim.

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