Newgen Case Study on Automated Health Claims Processing (for HCFA) using's OmniFlow

1. Case Study
S OLUTIONS F OR B USINESS P ROCESS & C ONTENT M ANAGEMENT
Automated Health Claim Processing
(for HCFA) using Newgen’s OmniFlow
For a leading US Insurance player
Overview
The client is One of the leading BPO companies that offer services for Health
Claims Processing. They process two types of HCFA forms - HCFA -
1500(HCFA) and HCFA-1450 (Ub92).
The Challenge
The BPO space, with the advent of new ways of conducting business and the
need for understanding customer requirements in a dynamic environment,
warrants cutting-edge technology.
The main objective for the automation of Health Claim Business process for
our client was to make the transaction processing service 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. .
The requirement entailed:
! Data entry of all fields from claim images
OmniFlow, Newgen's platform- ! Quality checks
independent, scalable Workflow ! Generation of EDI output files
solution and OmniDocs Newgen's
Enterprise Document Management HCFA-1500 is used for the Professional Claims and HCFA-1450 (also known
System, have been implemented and as UB-92) is used for Institutional Claims.These claim forms contain details of
the deployment done for the client is the patient, details of the illness, diagnosis, treatment etc. and are used by the
web-based. physicians and hospitals to claim the payment for services covered by
insurance providers.
The data captured in these forms has to be transferred to financial institutions
for payment purposes in EDI format. After processing of the claim forms, the
data has to be exported in to a standard EDI 837 file format, to be transferred to
the providers for further processing.
Solution
The solution broadly has 3 components:
! Upload and introduction to Workflow
! Health Claim Workflow Process with Quality Checks
! Export in EDI format
Production Site
O O EDI
SMS M M Export
(Image N N
server) I I
D F OmniFlow
O L Process Manager
C O / Dashboard
S W
D S OmniFlow
M E Desktop
Omni (Client)
S R
Flow,
V
Omni Upload to
E
Docs Workflow
R
Databas
e
www.newgensoft.com

2. Case Study
S OLUTIONS F OR B USINESS P ROCESS & C ONTENT M ANAGEMENT
Some of the winning characteristics of the solution are as follows:
! Flexibility of the solution for handling transaction capacity, processes,
technology and load-balancing. OmniFlow provides a single-window
based interface allowing data entry in the mainframe application of the
client, from the corresponding image of the claim form
! Process Manager helps the team leaders to access reports on the fly.
The team leaders can monitor the resources deployed, apart from
administration
! Stringent Quality Control is offered by the solution. The OmniFlow
Solution provides a mechanism to send only some percentage of the
claims to the list of tasks done by each data entry operator i.e. if a user
has processed some 100 claims today and his percentage of audit is set
to 10, only 10 claims of 100 goes to quality queue. For the client, 2
levels of quality check were provided
Newgen Software Technologies ! An accelerated learning curve was achieved as the solution and its
Limited is a market leader in BPM interfaces are very user friendly
and ECM, with impeccable track ! Newgen provided an aggressive implementation plan and the
record of implementing mission- deployment was done in a very short span of time
critical Workflow and Document
Imaging solutions. We have global The Benefits
footprint with an installation base of
more than 700 customers in over 30 The OmniFlow solution delivers impressive results and provides a unique
countries. More than 40 of our competitive edge to the BPO.
customers are Global Fortune 500
companies. We are known as one of Tangible
the fastest implementers of BPM
solutions in the world. ! Direct Productivity Enhancement:
a) Increased Employee Productivity
Winner of several awards such as b) Reduced and optimized turnaround time for health claims
Frost and Sullivan' “Market processing
Leadership Award for Document ! Cost Containment: OmniFlow enabled the BPO to service the
Management System and Workflow increasing transaction requirements without actually deploying
Software & Services” and additional resources of manpower and workstations
“Distinguished Application Product ! Reduced error cycles: This was achieved mainly by the dynamic logic
Company” by NASSCOM, Newgen parameters that can be set based on the user productivity, along with the
Software is an ISO 9001:2000, Stringent quality control provided. Mail triggers can be sent
ISO 27001 certified and CMM Level automatically when a particular error is reported or a particular claim is
4 company. Escalated
! Reduced manual desktop labor costs such as printing costs
Intangible
! Maximize Customer Relationships: The solution greatly enhanced
the BPO's ability to assimilate information and perform transactions
! Employee Morale: As the manual tasks were replaced with more
analytical activities, employees felt increasingly motivated
! Real-time feedback: Provide real-time feedback about the status of
processes. The Team Leaders gain better access to current
information anytime, anywhere on a browser. They can then
ensure that jobs are completed within stipulated times
! Flexible Integration: The solution's open APIs assure the BPO that
they will be able to find the best integration tools for accessing
legacy data, as well as any new formats the company may decide to
choose in the future
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
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HL -PTNI - 02
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