Newgen's OmniFlow and OmniDocs solutions were implemented to automate the dental claim processing for a large BPO company. This improved productivity by 25%, reduced errors, and cut processing time from 20,000 claims per day while requiring fewer resources. Key benefits included enhanced employee productivity, reduced costs, improved quality controls, and demonstrable results for winning new business opportunities.

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
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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
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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.
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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
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