OpenSpan for Healthcare in Claims and Customer Service

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In an ever-evolving industry, health insurers face a constant barrage of new regulations, increasing competitive pressures and rising costs that threaten their ability to deliver excellent service to new and existing members. To succeed, they must improve operational efficiency.

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  • Maximize your two biggest investments …People & Technologyby understanding and optimizinghow users interact with applications
  • Reduce cost-to-serveManage to Appropriate Handle Time Optimize People Resources – Training & SkillsEnable repeatable Gold Standard BehaviorMinimize redundant work Efficiently capture key insights & dataImpact everyone … Executives, Business Analysts, Supervisors, Agents!
  • OpenSpan for Healthcare in Claims and Customer Service

    1. 1. OpenSpan for HealthcareBetter Way to Work & Better Way to Manage
    2. 2. where people and technology meet© 2006-2013 by OpenSpan, Inc. All rights reserved.
    3. 3. What OpenSpan Means to Healthcare PayersIn an ever-evolving industry, health insurers face a constant barrage of newregulations, increasing competitive pressures and rising costs that threatentheir ability to deliver excellent service to new and existing members. Tosucceed, they must improve operational efficiency.Our health insurance customers are more agile. With OpenSpan they have asignificant competitive advantage in Claims and Customer Service becauseour automation and analytics tools help them:Recognize significant cost savings.Improve performance and raise customer satisfaction in the front office.Achieve record membership growth and retention.Maintain compliance in an environment of constant change.Best of all they saw results in weeks, not years.© 2006-2013 by OpenSpan, Inc. All rights reserved.
    4. 4. OpenSpan has solutions designed specificallyfor healthcare insurers…But we are used in virtually every other industry too, with Fortune 500customers in banking and financial services, telecommunications, retail andtechnology markets including:Three of the top six managed health plans in the Fortune 500.Three of the top five property and casualty insurers in the Fortune 500.Three of the U.K. “Big Four” and four of the top six U.S. commercial banksin the Fortune 500.Seven of the top global telecom/cable providers.One of the world’s three largest computer hardware manufacturers.Two of the top five U.S. food and drug retailers in the Fortune 500.© 2006-2013 by OpenSpan, Inc. All rights reserved.
    5. 5. OpenSpan’s innovativetechnology and deepexpertise in healthcareinsurance can help you boostproductivity enterprise-widewith near-immediate ROI.© 2006-2013 by OpenSpan, Inc. All rights reserved.
    6. 6. Customer ExperienceBetter Business Processes Mean Better Customer ServiceClient Project:This healthcare payer, a division of one of the largest insurancecompanies in the Southeastern United States, used OpenSpan’sClaims Repair Service to reduce average claims processing timefrom 11 days to just four.Project Results:Member and provider satisfaction has increased due to moretimely claim payments.Faster payment of claims has reduced claim inquiries to the callcenter by almost 75%.By significantly reducing the number of claims >15 daysold, prompt pay penalties dropped by 42% in the first year.© 2006-2013 by OpenSpan, Inc. All rights reserved.
    7. 7. Cost ReductionAutomation of Manual Claims Activities Means Dramatic SavingsClient Project:This major healthcare payer needed a faster way to add newproviders to their claim payment system to reduce errors,payment delays and labor costs associated with the time-consuming manual process.Project Results:The time to process new provider claims dropped from 30 daysto just one, significantly reducing labor costs, prompt paypenalties and duplicate claim submissions.Ultimately, OpenSpan improvements are expected to reduceadministrative costs by over $5,000,000 annually.© 2006-2013 by OpenSpan, Inc. All rights reserved.
    8. 8. Membership GrowthManage Growing Membership Without Increasing ExpensesClient Project:Membership at this payer was growing at 30% per year, and variableexpenses were climbing even faster. To handle the increasing volumeof claims, they selected OpenSpan’s Claims Automation Service.Project Results:With OpenSpan, the payer was able to eliminate up to 50% of themanual activities associated with processing suspendedclaims, including duplicates, authorizations, pricing and COBs.Due to increased efficiency in the claims operation, the payer didnot increase claim processing staff or budget.The payer was able to accelerate the on-boarding of newgroups and state programs, and improve consistency in claimpayment quality.© 2006-2013 by OpenSpan, Inc. All rights reserved.
    9. 9. Increased ComplianceBetter Visibility and Automation Help Reduce RiskClient Project:In a recent audit, this Fortune 500 insurer discovered that promptpay penalties were being calculated incorrectly. The payer consideredhiring additional claims examiners to manually review and correctthe errors.Project Results:Within four weeks the insurer had a solution in place using theOpenSpan Claims Automation Service which allows them toaccurately track and report prompt pay payments.The OpenSpan solution saved the company 25 potential newhires, and an additional $350,000 annually in labor costs related toprompt pay auditing on new claims.© 2006-2013 by OpenSpan, Inc. All rights reserved.
    10. 10. © 2006-2013 by OpenSpan, Inc. All rights reserved.
    11. 11. © 2006-2013 by OpenSpan, Inc. All rights reserved.

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