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When was the last time your management team ask to increase
staff to grow revenue? If your business is like most, the answer would be never.
Our approach to providing business solutions may be unorthodox at times. So, when
we were asked to conduct a workflow-reengineering  analyses
and develop a prototype system for a large prescription claims processing company
that's the solution we provided. Now, how did we do it ? Well, it wasnít
with smoke and mirrors just good old fashioned process measurement coupled with
a financial metric and a lot of creativity. About 40% of the companyís
claims were outsourced for data entry. It took six to ten days for turnaround
and adjudication (payment). Through a combination of technology, process reengineering
and staffing, the outsourced claims were brought back in-house for processing.
Even though this action increased claims volume, the standard claims adjudication
process was reduced to 3 days from 8 days, document preparation through-put increased
400% and daily end to end productivity increased by 30%. And, 40 people were hired!
Here is a summary of what we did:
- Merged (3) separate processes into one cohesive data entry event
- Introduced automated mail opening equipment in conjunction with bar code labeling
of claims header via key entry or voice generation
- Capture, storage and retrieval of paper claim and Rx by high speed image processing
input and sequel serve database access for output
- Automated workflow queuing, processing and tracking of claims exceptions and
payments
- Streamlined claims input via 21 monitor with graphical user interface presenting
split screen claim and Rx images, point and click data entry panels and real time
authorization for adjudication.
- Automated exception reporting, audit trails and productivity measurement
Here is a summary of tools we used:
- For Process Documentation - Visio and Erwin
- For Mail Equipment and Bar Coding - Datamation Inc.
- For Imaging - Kodak 900 series
- For Automated Workflow - InfoImage
- For Workstation GUI-Visual Basic, For rules definition - C++ and database
- MS SeQueL Server
- For Workstations - DEC Alpha with NEC 21 Monitor
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