Mav3rik is preparing to launch a Pega-based, AI enabled workflow solution designed to give aged care providers greater oversight of services delivered by third-party suppliers under Support at Home.
The CARE, or Care Allocation and Reconciliation Engine, solution will be launched at Pega Innovate Melbourne in August.
Mav3rik said CARE was intended to address an operational gap exposed by Support at Home, with providers retaining responsibility for outsourced care despite often having little real-time visibility of when third-party services are scheduled or delivered.
Providers may not receive confirmation that a service has occurred until an invoice arrives in their accounts payable system, often four to eight weeks after the care was delivered.
Administrative teams must then extract invoices from finance systems, match it against clients and service agreements, reconstruct or backdate service appointments, check supplier charges and calculate administration fees before claims can be submitted.
Mav3rik said the delays could also affect provider cash flow, as organisations may need to fund outsourced services from their own reserves while waiting to complete the administrative work required to claim government reimbursement.
It said claiming backlogs could extend for 30 to 60 days, while claims submitted after 60 days may enter Services Australia’s late-claims process and require additional justification and scrutiny.
Tracking brokered services
CARE is designed to sit between an organisation’s existing care management and finance systems rather than replace them.
Mav3rik said care management systems were generally not designed to process large volumes of unstructured financial information, while finance platforms lacked the client care plan, eligibility and service agreement information needed to validate outsourced services.
Built on Pega’s AI business rules and workflow platform, CARE creates and tracks a case for each brokered service.
When a third-party service is required, information from the care management system is sent to CARE, which can check that the client’s funding is active, verify agreed rates and select an approved associated provider according to the organisation’s business rules.
The case can then be tracked through supplier acceptance, scheduling, service completion, invoicing and final payment.
Associated providers can receive and accept work through a supplier portal or interactive email. They can also supply appointment details, confirm service completion and upload invoices and supporting evidence, giving the primary provider earlier visibility of planned and completed care.
CARE exchanges information with existing care management and finance platforms using scalable APIs.
Once an invoice is received, the system can match it against the original work order and the client’s service agreement, calculate the provider’s administration charge and send approved payment information to the finance system.
It can also record the completed service in the care management platform, creating an audit trail to support government claiming.
No more ‘flying blind’
The solution uses artificial intelligence to extract information from unstructured invoices, including PDF documents, and reconcile individual line items with work orders and approved services.
Invoices involving bundled services, recurring appointments or multiple clients can be routed through specialised workflows.
The system retains a human-in-the-loop process, isolating discrepancies such as supplier overcharges and budget overruns and sending only the affected items to staff for review.
CARE can also select suppliers according to an organisation’s business rules, including location, cost, previous client-provider relationships and preferred-provider arrangements.
Mav3rik health practice lead and registered nurse Eduardo Ferrão said delayed information was both a financial and clinical risk.
“The lack of visibility of services provided by associated providers, doesn’t just have a financial impact on aged care providers, it also has an impact on their client’s quality of life and the care they receive” Mr Ferrão said.
“If you don’t have an efficient way to communicate with providers, who might uncover unmet needs, or deteriorating conditions, during one of their visits, how can care be proactively managed? By relying on invoices as a form of communication our ability to manage client outcomes is severely compromised”
Mav3rik managing director Jon Gamble said the solution was developed to provide an alternative to lengthy custom technology projects.
“We built CARE as a solution accelerator because aged care providers don’t have eighteen months to wait for a custom-built automation framework,” Mr Gamble said.
“By deploying reusable matching engines and pre-built B2G rules, we can meet providers exactly where they are today, delivering a rapid return on investment and immediately compressing the claim lifecycle from weeks to under 48 hours.”
Mav3rik claims CARE can reduce manual reconciliation work by up to 70 per cent and shorten the claiming cycle from several weeks to less than 48 hours.
CARE features
- Data validation: Checks work orders and flags incomplete information in the originating care management system.
- Supplier coordination: Sends service requests and captures supplier acceptance, scheduling and completion details.
- Invoice reconciliation: Uses AI to extract invoice data and match individual line items against work orders and service agreements.
- Complex workflow management: Handles bulk invoices, bundled services and recurring appointments.
- Exception management: Routes overcharges, budget overruns and other discrepancies to staff for review.
- Systems integration: Exchanges information with existing care management and finance platforms to support payment and government claiming.
To learn more about the CARE solution please get in touch with the Mav3rik Health and Life Sciences team.
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