– HEALTH INSURANCE CLAIMS
Study: Imaging, Document
Management and web workflow developed for a workers’
Shield of New Jersey (HSNJ), a not-for-profit organization
headquartered in Newark, is the state's largest health insurer.
Health Casualty services an affiliate of HSNJ provides employers
with low cost workers' compensation insurance options, including
specialized managed care and claims administration (TPA) services
and allows New Jersey drivers, through designated insurers, access
to specialized auto injury management services and discounted
To increase revenues
and realize profits early, Health Casualty Services (HCS) needed to
decrease the time they take in adjudicating the bills/claims they
receive by automating the adjudication process (i.e. by processing
the bills/claims in a batch rather than one at a time). HCS required
their outsourcing partner to reengineer the process that would
result in achieving the desired efficiency cost effectively.
innovative solution involved a combination of onsite and offshore
deliverables to keep the entire proposition cost effective. We were
retained as their prime contractor to work closely with HCS on all
deliverables. Our onsite team included a system architect and a
project manager to interact with HCS team in developing the over all
schema of the new e-work flow.
comprised of two distinct phases for the claim adjudication process.
The solution required Value Momentum system architects to understand
the entire process through extensive dialogue with HCS personnel
necessary to design and develop web based application "Web
Track" enabling access to key data elements of the service
providers "database" over the internet. "Web
Track" would have "web bill" for delivering
intelligent information and web scan for indexing.
I. Delivering Intelligent Information (D2I) aimed at converting the
static / paper data in-to intelligent information. The process
involved HCS to scan the bills and ftp the images to our server in
India. Our offshore team in India will look at the image files and
enter the required information into pre-defined forms available
through WebTrak a web based application while entering this
information, The offshore team will also access provider information
through WebTrak and apply the same where necessary.
II. Webscan for indexing the service provider database on
specific fields in this case - claim number and claimant to
facilitate updating the required record in the database. HCS will
store all claim information in the database. HCS will scan all the
bills and ftp the image files to our server. Our operators in India
will look at the image file and get the claim number and the
claimant name. These values are then entered in the predefined form
in WebTrak and a search is done (on the database) to retrieve the
claim information. The relevant claim record from the database is
then linked to the image file and the link is stored in the
database. Elaborate QA procedure was defined to ensure data
integrity through the entire process.
is a satisfied customer reaping the twin benefits of a new process
that has enabled them to experience increased productivity at
reduced costs by a factor of 4X at the same time reducing the time
to revenue from a high of 3 weeks to 1 week. The relationship has
expanded in HCS retaining us as their out sourcing partners for an
extended period of time.