Improving a Claims Management Proccess


Posted in:

06.28.17

BCforward modernized a State agency’s Claim’s Management process. The system lacked efficiency, leading to long lead times for reimbursement.  The State needed to speed up the process while ensuring accuracy of information shared with citizens and governing entities.

The Challenge

The State needed a new system with industry standard workflow processing technology capable of supporting business processes while securing personally identifiable data. The system needed to provide a simple user experience to encourage information sharing across multiple organizations (law enforcement, healthcare providers, citizens, and agency employees).

The State’s outdated technology security managed data but performed inconsistently. Manual processes were managed through basic tools that lacked integration, which reduced the State’s ability to manage an effective audit trail for tracking purposes.  This silo’d approach limited multi-user functionality, and the lack of data integration caused reporting to remain basic and disjointed. As a result, the State’s processes required hours of manual research, data entry, and extensive documentation.

The Solution

BCforward proposed and developed an end-to-end solution with a user-friendly data entry approach customized to the user’s role.  This streamlined interactions with the system and created efficient methods to manage the entire compensation process through multiple workflows.

An assessment was performed to explore various options to meet the State’s needs.  The core features needed to reduce redundancies in functionality, while remaining powerful enough to process the client’s varying types of claims. To meet time and cost demands, BCforward leveraged pre-developed solution components that perform many of the standard processing requirements of the most demanding case management applications.

The components included secure collection of information captured via a web portal with data validation to confirm completeness of information collected before a user submitted.  Additionally, by defining optimized process workflows, the Agency was able to define the processing, status, and disposition of submissions based on pre-defined statutorily/procedural requirements.  Additionally, the solution integrated storage of electronic supporting documentation.

In addition to data entry, billing and payment processing requirements were met via components capable of accommodating variable workflows while maintaining the necessary documentation and records.  The solution can provide detailed records of both bills and payments with batch and single payment processing, adjustments, web billing, and reconciliation.

Outcomes

The new solution implemented by BCforward eliminated the manual data entry that made the process cumbersome. The improved electronic data sharing capabilities with secure role-based access reduced data privacy concerns. Most importantly, the workflow automation processes afforded the agency the ability to process claims quickly while providing accurate compensation.