Slide 1: Case Study
Outsourcing Enablement Framework- Healthcare
Automated Health Claims processing using Newgen’s Solution
About Newgen
Newgen Software Technologies Limited is a leader in the space of Business Process Management (BPM), Enterprise Content Management (ECM) and Highly Distributed Capture solutions with core competencies in Workflow and Imaging technologies. The company's solutions in the areas of Managed Care Enrollment and Claims Processing have helped numerous BPOs cut costs, manage their SLAs, reduce turn-around-times, and increase productivity, leading to continuous process improvement and innovation. Some of our esteemed customers include IBM Daksh, Dow Jones, WNS Global Services, UBS, Equinox, Patni BPO, Wipro BPO, EXL Services, iGate, Nipuna, Wividus,Unilever Indigo, Ranbaxy SSC, Phillips SSC, CoreBPO, Core3 Inc., iEnergizer and Techspan SSC The client is a pioneer in offshore and outsourced services to global insurance companies, and provides Health Claims Processing for a leading US Insurance player. The main objective for the automation of Health Claim Business process for our client was to make the transaction processing services more efficient, productive and streamlined. The client was looking for a unified business process workflow automation solution to support the business needs of its health claims processing and EDI output generation as per ANSI 837 standard guidelines. Some of the key challenges faced by the client were:
! Streamlining the processes to reduce the amount of re-work and number of errors caused due to ineffectiveness in meeting the SLAs ! Increasing accuracy and productivity levels to remove a huge backlog of claims in a short timeframe
The Client & their Challenge
The Solution
Newgen architected an automated Health Claims Processing solution for the client using platformindependent, scalable Workflow product – OmniFlow and Enterprise Document Management SystemOmniDocs .
Solution O v e r v i e w o f Automated Process
Solution details
SOLUTIONS FOR BUSINESS PROCESS AND CONTENT MANAGEMENT
Slide 2: Case Study
Outsourcing Enablement Framework- Healthcare
Some of the highlights of the solution are:
! The client receives images of the HCFA & UB claims in TIF format through a secured FTP ! These claim images are uploaded into a workflow and are distributed in queues for enabling the executives to process them ! Each associate retrieves the image from their queue and performs the data entry on a validation- enabled form created specifically for the process ! After data entry of the claims, they are routed by the workflow to the Quality Assurance personnel who check the data for all the fields in the forms ! A second round of Quality Assurance with a specified percentage of random sampling is conducted to eliminate any possible error ! The final data is routed to an EDI converter to convert the output to ANSI 837 output ! This output is uploaded to the client's secured FTP The Benefits
Newgen’s solution helped the client achieve significant tangible & intangible business benefits like:
! Significant cost reduction, system stabilization and process optimization; targeting and adhering to stringent service levels ! User-friendly interfaces of the solution helped improve the productivity from processing 8 claims per hour during the pilot phase to more than 25 claims per hour ! The solution helped the client achieve more than 99.5% accuracy through focused training of the end users, which is significantly higher than the 99% fixed in the SLA. ! The client has consistently been achieving a 24 hour turn-around in processing claims ! A huge backlog of claims was also processed ! As the manual tasks were replaced with more analytical activities, the client’s employees felt increasingly motivated ! The client was able to maximize their relationship with their customer through significant increase in productivity, accuracy and turnaround time ! Team Leaders gained better access to real-time information and were able to ensure that jobs are completed within stipulated times or ahead of them
Management Dashboard - Real Time Monitoring and Control
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 1364 Beverly Rd., Ste. 300, McLean, VA 22101 Tel: 703-749-2855 Fax: 703-749-2858 Email: usa@newgensoft.com Newgen Software Technologies Ltd., India A-6, Satsang Vihar Marg, Qutab Institutional Area, New Delhi 110 067 Tel: +91-11-26964733, 26963571, 26856871 Email: newgen@newgen.co.in UK Office: 68 Lombard Street, London EC3V, 9LJ, Tel: 2078681736 UAE Office: PO Box 120586, Sharjah Airport International Free Zone, Sharjah
www.newgensoft.com
E-mail: corpmkt@newgensoft.com
SOLUTIONS FOR BUSINESS PROCESS AND CONTENT MANAGEMENT
