Straight-through Processing Research Articles

The Basics of Robotic Process Automation in Insurance Claims

Through integrating Robotic Process Automation (RPA) and artificial intelligence, insurance claims processing has achieved unprecedented efficiency and accuracy. Key results include a 90% reduction in processing time (from 72 hours to under 5 minutes), 40-70% cost reductions in claims operations, and 99% accuracy rates for standard forms. Insurance carriers implementing RPA report transformative benefits: a 65% decrease in customer service costs, 92% automation of routine customer interactions, and improvement in Net Promoter Scores by 30 points. The technology has particularly excelled in fraud detection, with AI-augmented systems identifying 53% more potential fraud indicators and saving mid-sized insurers an average of $4.2 million annually. Leading organizations are now achieving straight-through processing rates of up to 75% for standard claims, demonstrating how RPA is setting new benchmarks for operational excellence in insurance claims management

Navigating ISO 20022 maintenance in a connected world: A vision for harmonisation

The implementation of ISO 20022 in payment infrastructures has been hailed as a paradigm shift towards seamless transactions, heralding flexibility for financial market infrastructures (MIs) and enabling the creation of bespoke ISO 20022 variants. The initial allure of this flexibility, however, led to an unintended consequence — a proliferation of variants with different timelines, versions and market practices. This fragmented landscape has introduced challenges for organisations seeking to achieve high levels of automated ‘straight-through processing’. Different variants affect end-users’ ability to automate reconciliation processes and complicates endeavours to establish and sustain a cohesive ISO 20022 future. As we navigate the intricacies of a globally interlinked financial ecosystem, the role of ISO 20022 maintenance has emerged as a linchpin in the seamless exchange of standardised financial messages. This paper emphasises the importance of streamlining the ISO 20022 environment and messaging life cycle to facilitate efficient maintenance processes, foster broader harmonisation and usher in an era of truly frictionless payments. In proposing this shift, the paper advocates for a transformative approach. It posits two opportunities: the establishment of a unified, industry-led governance structure and the definition of a common message template. These initiatives are envisioned as essential to harmonising the fragmented ISO 20022 landscape, offering a path for end-to-end interoperability across the diverse payment chain. While acknowledging the ambitious nature of these proposals and timelines, the potential benefits are significant. The proposed initiatives could lead to more efficient maintenance processes, enhanced interoperability and a shared framework for ISO 20022 payments. The industry faces a crucial choice — whether to embrace this ambitious evolution or settle for the status quo. The imperative is clear: achieving a more interoperable and harmonised future for ISO 20022 payments is not just an opportunity but a necessity for the industry’s continued growth, resilience and operational efficiency.

KAMEL: Knowledge Aware Medical Entity Linkage to Automate Health Insurance Claims Processing

Automating the processing of health insurance claims to achieve "Straight-Through Processing" is one of the holy grails that all insurance companies aim to achieve. One of the major impediments to this automation is the difficulty in establishing the relationship between the underwriting exclusions that a policy has and the incoming claim's diagnosis information. Typically, policy underwriting exclusions are captured in free-text such as "Respiratory illnesses are excluded due to a pre-existing asthma condition". A medical claim coming from a hospital would have the diagnosis represented using the International Classification of Disease (ICD) codes from the World Health Organization. The complex and labour-intensive task of establishing the relationship between free-text underwriting exclusions in health insurance policies and medical diagnosis codes from health insurance claims is critical towards determining if a claim should be rejected due to underwriting exclusions. In this work, we present a novel framework that leverages both explicit and implicit domain knowledge present in medical ontologies and pre-trained language models respectively, to effectively establish the relationship between free-text describing medical conditions present in underwriting exclusions and the ICD-10CM diagnosis codes in health insurance claims. Termed KAMEL (Knowledge Aware Medical Entity Linkage), our proposed framework addresses the limitations faced by prior approaches when evaluated on real-world health insurance claims data. Our proposed framework have been deployed in several multi-national health insurance providers to automate their health insurance claims.

Centralized Database and Automation: Key to Overcome the Challenge of Missing or Inaccurate Standard Settlement Instructions

To achieve effective and automated payment processes, straight-through processing (STP) has been implemented in the financial sector. The implementation of STP is, however, still hampered by the existence of incorrect or absent standing settlement instructions (SSIs). This research study explores the reasons of missing or incorrect SSIs in the banking sector, their effects, and potential fixes. The complexity of the situation is further increased by the examination of the variety of channels used by parties to transmit their SSIs. According to the report, incomplete or inaccurate SSIs are a significant cause of payment failures and unneeded expenses, hence a workable solution is required. The research recommends the implementation of a centralized SSI database that can be accessed by all parties involved in the payment process, as well as the automation of SSI updates to ensure accuracy and efficiency.

Funding primary health care service delivery in the West Nile sub-region, Uganda

The provision of primary health care services is a global concern and quality health service delivery is based on a number of factors, including motivated health workers, good-quality infrastructure, consistent supply of medicines and technologies, adequate funding, sound health plans, and evidence-based policies. This study investigated the funding of primary health care service delivery in three local government districts in Uganda’s West Nile sub-region, and identified deficiencies in the allocation, disbursement and timeliness of health funding which have a negative impact on service delivery. Inadequate funding affects the quality of services, limits essential supplies and causes excessive reliance on private financing, which is not sustainable in poor rural economies. In view of these findings, the study recommended deliberate action by both central government and district councils to increase the percentage of funding allocated in their annual budgets to the health sector, in line with the 2001 Abuja Declaration. The government of Uganda should consider prioritising an increase in total national budget allocations to local governments; primary health care disbursements from central government should be paid on time directly to health facilities by use of the ‘straight-through processing system’ for all types of funding; the government should introduce, support and encourage additional community financing initiatives such as Community Health Insurance Schemes; and district and local community leaders should be sensitised on the benefits of this approach.

Data misrepresentation detection for insurance underwriting fraud prevention

Premium fraud concerns data misrepresentation committed by an insurance customer with the intent to benefit from an unduly low premium at the underwriting of a policy. In this paper, we propose a novel approach for evaluating the risk of underwriting premium fraud at the time of application in the presence of potentially misrepresented self-reported information. The aim of the approach is to support insurance companies in identifying fraudulent applications and their decisions to underwrite insurance contract propositions. Likewise, it can be use to make straight-through processing (i.e. automated) underwriting systems more fraudproof, by e.g., triggering a validation on applications prone to misrepresentations. Our approach is based on conditional density estimates for a set of validated contracts. The proposed approach does not require historical fraud labels and can adapt to changes in pricing policy. Moreover, the approach can be used to detect outliers in addition to predicting underwriting fraud and is extended to multivariate self-reported data. We further demonstrate a link between Shapley values in common conditional expectation problems and conditional density estimations to make our approach explainable. We report a case study involving motor insurance underwriting, in which a driver's identity and driving record can be misrepresented to benefit from an unduly low premium; the results indicate the effectiveness of the proposed approach for detecting and preventing underwriting fraud.

A Shared Information Technology-Business-Health Model: Lessons for Healthcare Leaders on Integrating Technology from Investment

Objective: Technology is rapidly shifting our day-to-day existence, education, social relationships, health care and business. Psychiatric leaders have slowly explored telepsychiatric services – but few have an approach to technology in general–due to competing clinical, educational and research demands. Technology has typically been added on, rather than integrated, to institutional functions. Method: This narrative review used a literature search of Medline, PsycNET, PsycINFO, Embase, Cochrane, SpringerLink, Scopus, ABI/Inform, Business Source Complete, and Web of Science, using subject headings and keywords along with a manual search of reference lists of articles published by November 2020. The keywords explored four areas: 1) business; 2) service delivery; 3) system change; and 4) technology. Articles were reviewed by title/abstract, full text review and review of references. They were included if they discussed integration of technology into health care and compared literature from medicine/health, psychiatry/behavioral health, business, technology, leadership and health care administration. The goal was to explore how medicine/psychiatry has integrated technology compared to business, and apply business approaches to health care and training. Results: From a total of 2,710 potential references, two authors found 327 eligible for full text review and found 69 papers directly relevant to the concepts. Business and medicine/psychiatry have similarities/differences from both historical and contemporary views. Many health care systems and companies lack a strategic plan for technology and focus only on short-term due to administrative demands. Clinical informatics is a rapidly expanding area and would be central to this process. It has started to facilitate patient-centered care as defined by quality, affordable, and timely health care. While in principle information systems use integrative approaches, electronic health records, electronic means of communications with patients and staff, behavioral health indicators and related digital advances are often added to existing systems rather than integrated. Effective businesses use integrative approaches to share domain knowledge and streamline practices to link information technology (IT) with research and development, production, financing and marketing management. A case example highlights the IT strategy and business leaders’ comments in shifting to straight through processing (STP) from the banking industry for investments. It also exemplifies a model of shared IT-business understanding, which improves performance via efficiency, quality of data/information processing/integration and managerial teamwork. Conclusion: When it is integrated into health care service delivery workflow, evaluated and quality improved, IT facilitates the translation of strategic planning into organizational change. Incremental versus strategically innovative approaches to technological integration for care, education and administration are considered. Successful implementation requires a needs and impact assessment for patients, staff, clinicians and leaders across all levels of the organization. Benefits to the mission, limited disruptions of core operational workflow and reasonable costs reduce the likelihood of failure.

Moving an entire banking sector onto DLT: The Italian banking sector use case

Blockchain technology has in recent years gained significant appeal worldwide in view of its potential to transform the way we do business. In this regard, one of the most attractive architectural concepts is the consortium Blockchain, where a group of peers, leveraging a common governance, collaborate to define rules and technology development. A consortium Blockchain is highly beneficial in a setting where multiple organisations operate in the same industry, but it is not immune from challenges, including investment, education and data standardisation. This paper provides an analysis of the evolution of Blockchain and Distributed Ledger Technology (DLT) technologies and the regulatory approach along with a practical case study on the use of Blockchain in the Italian banking sector. This sector has successfully pioneered the use of Blockchain/DLT with a new application, Spunta Banca DLT, for straight-through processing of interbank reconciliation. Finally, challenges, opportunities and important learnings are discussed.

Electronic invoicing: The first step towards digital B2B payment modernisation

US payments systems are in the midst of vital modernisation to meet the changing dynamics and demands of digital and global commerce. While social media and consumer payments have blossomed with internet connectivity, the underlying payments infrastructure in support of business-to-business (B2B) payment digitization and connectivity lags behind. Payment modernisation for B2B payments requires establishment of an infrastructure that enables end-to-end automated processing of electronic payments through the digitisation and exchange of supporting remittance information to effectively connect payments to invoices. There are four essential facets to B2B payment modernisation— 1) sending structured electronic invoices that can be automatically processed by the buyer; 2) paying the supplier electronically; 3) sending sufficient payment remittance information electronically to link the payment back to the original invoice; and 4) facilitating greater connectivity and interoperability between businesses to enable the previous three facets. Solving all four is necessary to complete the modernisation and digitisation of B2B payments and reduce unnecessary payment processing complexity, costs and inefficiency and to enable value-added service innovation opportunities for financial institutions, payment processors and corporations. This paper discusses the benefits, challenges and possible solutions to achieving the first step in the process, sending structured electronic invoices that can be automatically processed by the buyer, based on work performed by the Business Payments Coalition which was originally formed and coordinated by the U.S. Federal Reserve. The Business Payments Coalition is a group of payment industry volunteers working together to advocate for industry innovation to solve B2B payment inefficiencies and achieve straight-through processing of electronic payments.

Process for Continuous Fab Production by Digestion of IgG

Intensified processing and end-to-end integrated continuous manufacturing are increasingly being considered in bioprocessing as an alternative to the current batch-based technologies. Similar approaches can also be used at later stages of the production chain, such as in the post-translational modifications that are often considered for therapeutic proteins. In this work, a process to intensify the enzymatic digestion of immunoglobulin G (IgG) and the purification of the resulting Fab fragment is developed. The process consists of the integration of a continuous packed-bed reactor into a multicolumn chromatographic process. The integration is realized through the development of a novel multicolumn countercurrent solvent gradient purification (MCSGP) process, which, by adding a third column to the classical two-column MCSGP process, allows for continuous loading and then straight-through processing of the mixture leaving the reactor.

Will Blockchain Become the New Operational Backbone in Energy?

As digital innovations such as artificial intelligence, cloud computing, automation, and the Internet of Things (IoT) become more readily usable, energy companies are developing strategies that incorporate these burgeoning systems into their operational infrastructure. Distributed ledger technology—otherwise known as blockchain—may be the backbone of this new infrastructure. Already well-known in the financial sector, blockchain is a peer-to-peer (P2P) network technology that uses advanced computer science techniques to enable trustworthy interactions between parties, even if those parties do not trust each other. It is a shared electronic ledger in which access can be managed by multiple sources, including anonymous ones. Proponents say blockchain is reliable and likely to change the way in which energy companies perform transactions. Operators are already working with various blockchain platforms, but the developers of these platforms are still forging a path that they hope will lead to widespread adoption within the industry. The Mechanics of Blockchain Fig. 1 illustrates the basics of a blockchain platform. An entity requests a transaction, the transaction is broadcast to a P2P network, validated, combined with other transactions to create a block of data within a ledger, and added to a chain of previous transactions in a way that is permanent and unalterable. These transactions can represent anything, from the exchange of numbers of digital assets to the acceptance of a trade of a digital commodity that can be audited by a third party for authenticity without revealing sensitive information. The blockchain ledger can be shared with all members at all times. It is not stored in one place, and there is full transparency—companies can control exactly which information gets shared and with whom. A blockchain entry can include executable computer code that reflects the terms of the contract, creating a smart contract that automatically validates transactions without the need for human intervention. A smart contract selfexecutes code that enables straight-through processing and eliminates the need for manual intervention in the execution of a transaction. Smart contracts can mimic regular contracts and execute the contract automatically if the conditions required to consummate the contract are met. Jerry Bailey, director and president of Petroteq and a former senior executive engineer at Exxon, compared blockchain to traditional means of storing information. “We all have had big file cabinets, big file rooms all through the years,” Bailey said. “You go into a file room and find dozens of file cabinets. Everybody had a key to the file room but not everybody had a key to each of the file cabinets, depending on what their part in the company was. Blockchain is like this to me. It sets up a system where not only the company, but our vendors, our suppliers, and our buyers can look into the appropriate file cabinet, as it were.”

Securities settlement revolution in Japan: The future of securities settlement

This paper examines the efforts planned and in progress to shorten the settlement cycle of Japanese government bonds ( JGBs) from two business days after the trade date (T+2) to one (T+1). This report on the so-called ‘securities settlement revolution’, focuses on key trends and changes in the securities settlement market of Japan while exploring legacy systems and ecosystem migration as well as the related possibilities of innovation and emerging technologies in this context. The revolution currently underway in Japan is tackling the below five areas: (1) initiatives to shorten the settlement cycle for JGBs and securities; (2) efforts to enhance the functions, expand use, improve linkages and integration of the central counterparty (CCP); (3) enhanced functions of the central securities depositories (CSD); (4) accelerated adoption and use of straight-through processing (STP) by market participants; and (5) facilitating smoother cross-border securities settlement. The first chapter in this revolution is to be planned for the spring of 2018. In 2012, the market successfully introduced a settlement cycle that was shortened to two business days (T+2) for outright JGB transactions and SC repos (special collateral repurchase transactions) and one business day (T+1) for GC repos (general collateral repurchase transactions and together collectively regarded as T+2). The upcoming revolution builds on this with the aim of shortening this settlement cycle to T+1, one business day after a trade.

Design and operation of a continuous integrated monoclonal antibody production process.

The realization of an end-to-end integrated continuous lab-scale process for monoclonal antibody manufacturing is described. For this, a continuous cultivation with filter-based cell-retention, a continuous two column capture process, a virus inactivation step, a semi-continuous polishing step (twin-column MCSGP), and a batch-wise flow-through polishing step were integrated and operated together. In each unit, the implementation of internal recycle loops allows to improve the performance: (a) in the bioreactor, to simultaneously increase the cell density and volumetric productivity, (b) in the capture process, to achieve improved capacity utilization at high productivity and yield, and (c) in the MCSGP process, to overcome the purity-yield trade-off of classical batch-wise bind-elute polishing steps. Furthermore, the design principles, which allow the direct connection of these steps, some at steady state and some at cyclic steady state, as well as straight-through processing, are discussed. The setup was operated for the continuous production of a commercial monoclonal antibody, resulting in stable operation and uniform product quality over the 17 cycles of the end-to-end integration. The steady-state operation was fully characterized by analyzing at the outlet of each unit at steady state the product titer as well as the process (HCP, DNA, leached Protein A) and product (aggregates, fragments) related impurities. © 2017 American Institute of Chemical Engineers Biotechnol. Prog., 33:1303-1313, 2017.

Development of a 3-step straight-through purification strategy combining membrane adsorbers and resins.

The pressures to efficiently produce complex biopharmaceuticals at reduced costs are driving the development of novel techniques, such as in downstream processing with straight-through processing (STP). This method involves directly and sequentially purifying a particular target with minimal holding steps. This work developed and compared six different 3-step STP strategies, combining membrane adsorbers, monoliths, and resins, to purify a large, complex, and labile glycoprotein from Chinese hamster ovary cell culture supernatant. The best performing pathway was cation exchange chromatography to hydrophobic interaction chromatography to affinity chromatography with an overall product recovery of up to 88% across the process and significant clearance of DNA and protein impurities. This work establishes a platform and considerations for the development of STP of biopharmaceutical products and highlights its suitability for integration with single-use technologies and continuous production methods. © 2017 American Institute of Chemical Engineers Biotechnol. Prog., 33:931-940, 2017.

STP technology for global financial services: critical success factor, implementation model, and case study

For the last decade, straight through processing (STP) has been a catch phrase in the securities markets, reflecting the industry's continued pursuit of moving electronically through a trading process from initiation through post-execution and final settlement without manual intervention. To bring forth the full benefits of STP, this study presents a conceptual framework that takes into consideration the distinction between internal processes and external processes as well as the integration level and connectivity between the two types of processes. Cumulative benefits from the implementation of such a conceptual framework are discussed. Moreover, this study identifies two clusters of critical success factors (CSFs) and four suitable models to guide STP implementation practice. Case studies in the end exemplify benefits attained from implementing STP with sensible consideration of CSFs and proper application of implementation models.

STP concept in the function of increasing efficiency and effectiveness in the Rapp Marine Group

Straight-Through Processing appeared as a response to problems surfacing in the conditions of the insufficient connectedness of pieces of information from trading and financial flows. The application of the STP concept is most important in international trading because all the shortcomings of an insufficient integrity are especially emphasized in that particular case. In traditional conditions, international trade is characterized by numerous manual activities, a large number of intermediaries and documentation, lack of documentation and big losses. Standardization of electronic documents is very important to ensure their flow between partners within the financial supply chain. E-invoicing is a concept that cannot be implemented independently of other processes in the company, and precondition for proper and full implementation of e-invoicing is definitely high quality of the procurement process.

Coping with European regulatory requirements for automated trading: Best practices and new requirements resulting from regulation

Risks resulting from large trade and order volumes made possible by the automation of trading processes have been steadily climbing the agenda of regulators — even before the publication of books capturing the popular imagination. At the same time, it is widely accepted that automation significantly reduces the risk of ‘classical’ mistakes like fat fingers, with regulation increasingly explicitly or implicitly demanding straight-through processing and setting limits for trade-related processing which, without a highly automated trading environment, are not achievable. Nevertheless, even where automated trading is used only in a conservative way, the volume of trades in a volatile market can impact risk management and order facilities. This paper discusses the implications for operational risk management of the requirements introduced by the Markets in Financial Instruments Directive (MiFID) II in Europe for a firm using automated trading to support market-making and risk management across a number of different markets and products.

Industrialisation of securities and derivatives transaction processing: Silos in the past, platforms today and functional modules in the future

From the point of view of operations, the development in the last decade of securities and derivatives processing can be described as ‘from manufacture to machinery’. As in many other industries — with the most prominent example being the automotive industry — ‘industrialisation’ has taken place to optimise production processes. Typical approaches, such as sourcing decisions (‘make or buy’), process automation and efficiency improvement (ie straight-through processing, ‘STP’) to generate cost-savings, optimisation of process quality and reduction of operational risk, have been used increasingly in the banking industry. In securities and derivatives transaction processing, this industrialisation has led development from asset-focused silos to cross-asset processing platforms; however, the dramatic increase in regulatory requirements has provided the catalyst for the next step in industrialisation. In parallel, there has been a shift from manual processing along the transaction processing chain to nearly full STP coverage on the transaction level plus manual functions on a meta-level. After a review of the recent developments from ‘silos to platforms’, this paper will discuss future progress. From the perspective of DZ BANK, regulation and automation will require an operating model analogous to the future one envisaged for the automotive industry. The requirements of flexibility to substitute asset classes and the target of full automation based on a once-and-final set-up of transaction parameters result in a ‘modular’ approach or combined elementary function blocks delivered from selected sourcing options. DZ BANK is continuously developing this approach, and first experiences will be discussed here.

Dynamic Adaptation of Processing Steps For Financial Messaging

In the business-to-business area of financial services firms, financial messaging is the backbone for processing financial transactions such as currency payments. Firms implementing these solutions require high levels of straight-through-processing (STP) and flexible processing configurations. Experience shows that decisions about the processing steps are dependent on various parameters, which can change during the processing life cycle of a financial message. This could be due to something like a missed deadline where special agreements for important customers need to be considered. To handle these situations, externalise the processing behaviour and to allow dynamic updating of the sequence of processing steps, the author invented the dynamic adaptation of electronic routing slips. The dynamic adaptation is based on financial message control information, processing status of the message and environment variables that direct the processing of the financial message. The financial message control information is derived from the sender, receiver, message type, clearing system and currency. The processing status of the message is determined at each step of the process. Environment variables are based on conditions that can change, or processing timeframes.

Cloud computing technology (with BPOS and Windows Azure)

We see cloud computing offerings today that are suitable to host enterprise architectures. But while these offerings provide clear benefit to corporations by providing capabilities complementary to what they have, the fact that they can help to elastically scale enterprise architectures should not be understood to also mean that simply scaling in this way will meet 21st century computing requirements. The architecture requirements of large platforms like social networks are radically different from the requirements of a healthcare platform in which geographically and corporately distributed care providers, medical devices, patients, insurance providers, clinics, coders, and billing staff contribute information to patient charts according to care programs, quality of service and HIPAA constraints. And the requirements for both of these are very different than those that provision straight-through processing services common in the financial services industry. Clouds will have to accommodate differences in architecture requirements like those implied here, as well as those relating to characteristics we subsequently discuss.