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Automated dental claim processing using newgen's omni flow

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Newgen Case Study on Automated Dental Claim Processing using Newgen's OmniFlow.

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Automated dental claim processing using newgen's omni flow

  1. 1. Case Study HEALTHCARE S OLUTIONS F OR B USINESS P ROCESS & C ONTENT M ANAGEMENT Automated Dental Claim Processing using Newgen's OmniFlow Dental Claims Processing for a leading US Insurance player Overview The client is a fully owned subsidiary of a leading IT services company from India and provides Business Process Outsourcing (BPO) services. They offer industry specific BPO services for verticals that include Insurance, Healthcare, Banking, Financial Services, Telecom and Retail. The BPO space is a very competetive business environment and is characterized by: ! Pricing Pressures that force BPOs to squeeze every bit of efficiency they can out of their operations ! The BPO space is highly productivity driven. Each and every level of internal productivity is measured ! Quality standards maintained by the BPO are a critical yardstick “ We c o n s i d e r t h e s o l u t i o n measured by the outsourcing client implementation an unqualified ! Employee Morale has to be taken care of, as attrition rates are very high success. Our users confirm that in the industry Newgen products have helped in improving the productivity of the The Challenge agents by over 25%.” The BPO faced various limitations of which a critical pain area was Head, Network and Systems Operational Control. Some of these limitations were: ! Productivity Constraints: The images of claim forms received from US had to be segregated and allocated manually to the data-entry operators. The data entry operators would then complete their work and then fill summary of their claims processed and the title of the claim in an excel sheet. These forms would be collected by the respective Team Leaders and analyzed. This increased the workload unnecessarily and for processing 20,000 claim forms, the BPO would have to amploy double the workforce and the number of workstations of what they had currently ! Manual Process prone to Errors: The data entry operators used to print the images and based on the physical copies, used to enter the data on the client's application ! No Quality Checks were being done on the data entry work. A stringent Control process was required, so that quality checks could be performed On the image assisted data entry and reports could be generated on the fly. Growing competition made t imperative for the company to take a new look at the way it handled processes for its clients. As a young company fighting for business in market - it is important for the BPO to make it as easy as possible to do business for its clients. The desired system needed to have robustness, flexibility and cost-effectiveness to integrate with 3rd party applications ! Accountability of associates was difficult. For monitoring and reporting facilities, the supervisors had to depend on spreadsheets filled by individual associates and finally collate the figures ! The decision-making process for optimum resource deployment was severely impaired because clear visibility of processes and activities was missing www.newgensoft.com
  2. 2. Case Study HEALTHCARE S OLUTIONS F OR B USINESS P ROCESS & C ONTENT M ANAGEMENT ! From a business perspective, the client was looking for a solution, which could demonstrate the Proof of Concept to its client in very tight deadlines. Competing workflow solutions would have required upto 6 months for deployment. This was unacceptable in the demanding scenario ! The growth of new ways of conducting business, such as understanding customer requirements in a dynamic environment, requires cutting-edge BPO technology The NEWGEN Solution The Newgen Solution implemented is web based and consisted of: OmniFlow - Newgen's platform-independent, scalable Workflow solution. OmniDocs Newgen's Enterprise Document Management System. The solution has helped in moving business processes online in real time. ! Claims are scanned in US ! Uploaded via FTP to India, for processing ! This process includes data entry, quality checks, etc ! Every claim form is returned back into client's DB OmniFlow, Newgen's platform- independent, scalable Workflow solution and OmniDocs Newgen's Enterprise Document Management System, have been implemented and Unpendable Stage the deployment done for the client is Rejected Claim – Team web-based. Leader accesses and report sent to client. Data Entry Stage Quality Stage Initiation Stage Completed Stage Scanned Images In Client Dynamic Audit Utility running (Refer Point Claims for which all introduced into the Application #) the processing is process and auto , accessed complete. allocated to users by the Associates Escalation Stage Claims, which are escalated at data Entry - attended by Team Leads Activity done at US-based client’s place Processes undertaken at BPO in India Process Manager Monitors processes, user performance, and accesses a list of important reports - Claims Assigned report, Data Entry report, Data Entry Comparison Report, Error reports, TAT reports, etc. Automated Processing www.newgensoft.com
  3. 3. Case Study HEALTHCARE S OLUTIONS F OR B USINESS P ROCESS & C ONTENT M ANAGEMENT Some of the winning characteristics of the solution were as follows: 1.Flexibility of the solution for handling transaction capacity, processes and technology (OmniFlow provides a single-window based interface allowing data entry in the mainframe application of the US-based client from the corresponding image of the claim form) and load-balancing. 2.Process Manager tool helped the team leaders to access reports such as Turn Around Time Reports on the fly. Now the team leaders could monitor the resources deployed apart from administration. 3.Stringent Quality Control was provided by the solution. (Note: Solution provides a mechanism to send only a percentage of the claims processed by each data entry operator for audit. E.g. if a user has processed 100 claims in a day and his percentage of audit is set to 10, only 10 claims out of 100 goes to quality queue). 4.Accelerated learning curve: Team at the BPO showed results within 1 week as they found the solution very user-friendly. (The client's expectations were 3 weeks of learning curve). Key Benefits 5. The solution has been implemented in an aggressive span of 2 months. ! Direct Productivity Enhancement The BPO is intent on maximizing the value of its strategic investment in OmniFlow solution. It foresees two-fold usage of the application : ! Cost Containment ! It has plans to utilize the solution for its internal workflow (e.g. HR ! Reduce error cycles Recruitment process) ! Reduced manual desktop labor ! The BPO plans to use Newgen's solution for Business Development costs of USD 20,000 per month activities. It plans to use the solution to demonstrate the proof-of concept to its prospects. Once a pilot has been demonstrated to the BPO's prospect, the former would be able to make “Live” the customer's processes in shortest possible time. The Benefits The OmniFlow solution for the client has delivered impressive results. It has provided a unique competitive edge to the BPO. 1. Direct Productivity Enhancement: a. Increased Employee Productivity: Enables processing over 20,000 transactions per day, which are divided among 80 associates with a throughput of 250 per shift per person. This access significantly reduced an associate's unproductive time of printing the images, collating information on spreadsheets, etc. In the customer's own words, the solution has at least improved the productivity of its associate from processing an estimated 150 transactions per day to 250 per day. At Data Entry Stage each user takes around 1 minute to process a single page transaction and 2-3 minutes for a multi page transaction image. b. The turnaround time for a claim form and its being reported back to the client has been reduced to 12 hours. www.newgensoft.com
  4. 4. Case Study HEALTHCARE S OLUTIONS F OR B USINESS P ROCESS & C ONTENT M ANAGEMENT 2. Cost Containment: The BPO is able to service the customer's increasing transaction requirements without actually deploying additional resources of manpower and workstations. The BPO is set to draw an opportunity cost benefit of over USD 100,000 in Manpower and Workstation costs. 3. Reduce error cycles: The Client is able to achieve accuracy of 99.90%. This is mainly because of the dynamic logic parameters that can be set based on the user productivity. Mail triggers can be sent automatically when a particular error is reported or a particular claim is escalated. The solution assists the BPO in their pursuit to achieve the six-sigma initiative by providing real-time information on process stages. OmniFlow provides monitoring and control reports for the six-sigma team to keep a track of production and Turn Around Time details. 4. Reduced manual desktop labor costs of USD 20,000 per month. About Newgen Key Highlights Newgen Software Technologies Limited is a market leader in BPM and ECM, with impeccable track record of implementing mission-critical Workflow and ! Enables processing over 20,000 Document Imaging solutions. We have global footprint with an installation transactions per day base of more than 700 customers in over 30 countries. More than 40 of our customers are Global Fortune 500 companies. We are known as one of the ! The turnaround (TAT) time has fastest implementers of BPM solutions in the world. been reduced to 12 hours Winner of several awards such as Frost and Sullivan' “Market Leadership ! Accuracy of 99.90% has been Award for Document Management System and Workflow Software & achieved Services” and “Distinguished Application Product Company” by NASSCOM, Newgen Software is an ISO 9001:2000, ISO 27001 certified and CMM Level 4 company. Newgen prestigious clients include Max New York Life, HSBC, Deutsche Bank, ABN AMRO, ICICI Bank, HDFC Bank, Hua Nan Commercial Bank, Bajaj Allianz, Sahara Life, Royal Sundaram Alliance, IBM Daksh, Wipro BPO, Dow Jones, WNS, UBS, Equinox, Patni BPO, Wividus, Unilever SSC, Ranbaxy SSC, Airtel, Hutch, Idea, Etisalat UAE, Reliance Infocomm, Tata Tele Services, GSL Hongkong, Praxair, Philips, SEC Philippines, Trent Limited, Kuoni Travels and Kenya Airways Newgen Software Inc., USA Corporate Office 1364 Beverly Rd., Ste. 300, McLean, VA 22101 Newgen Software Technologies Ltd. www.newgensoft.com Tel: 703-749-2855 Fax: 703-749-2858 A-6, Satsang Vihar Marg, Qutab Institutional Sales & Support Hotline: +1-800-499-5074 Area, New Delhi 110 067, INDIA Email: usa@newgensoft.com Tel: +91-11-26964733, 26963571, 26856871 www.newgensoft.com Email: corpmktg@newgensoft.com HL - NPU - 03 This material belongs to Newgen marketing kit. The information contained herein is liable to change without notice and the user is advised to consult Newgen for getting the latest information. © Copyright 2006-2007 Newgen Software Inc. All rights reserved.