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Claims Document Workflow

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Claims Document Workflow

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Claims Document Workflow

  1. 1. Ahshay! (I found it!) Claims Document Workflow Solution By Wilson Koh
  2. 3. True Story 2008 2009 Difference Total Claim 74000 79000 +7% Users 60 58 - 3% Inbound mail pages /day 7600 3500 - 54% Scanned pages/month 116,000 68,800 - 33% Incoming fax pages/month 23000 18800 - 18% Outgoing fax pages/month 1840 2460 + 25% Outgoing mail letters/month 647 891 + 37%
  3. 4. Testimonials by Customers <ul><li>Overall 25 – 50% on Productivity Improvement </li></ul><ul><li>More Time For Strategic Claim Handling </li></ul><ul><ul><li>Reduce Total Claim Cost </li></ul></ul><ul><li>Less Redundancy </li></ul><ul><ul><li>Redundant Bill Processing = $10 To $17 / bill </li></ul></ul><ul><li>3 rd Generation Efficiency </li></ul><ul><ul><li>Real Time Access by All Levels At The Same Time </li></ul></ul><ul><li>Eliminate Paper Chase </li></ul>
  4. 5. Ahshay Integration
  5. 6. New Mail Room
  6. 7. Document Workflow Processing <ul><li>How Scanned Files Are Routed To Adjusters </li></ul><ul><li>View Multiple </li></ul><ul><li>Search & Send </li></ul><ul><li>Fax/Email log </li></ul><ul><li>Viewer/Forward log </li></ul><ul><li>Auto-fill Forms </li></ul>
  7. 8. Notification of New Doc Claims with Pending Doc
  8. 9. Bill Approval Process <ul><li>Process Imaged Bills via Ahshay </li></ul><ul><li>Sending it to Bill Review via EDI </li></ul><ul><li>Know what stages your bills are at </li></ul>
  9. 10. Management Reports <ul><li>View Claims with Pending Documents for All Adjusters </li></ul><ul><li>View All Claims for All Adjusters </li></ul><ul><li>Search Through All Claims </li></ul><ul><li>Search Through All Documents </li></ul>
  10. 11. Bill Adjuster
  11. 12. Who View the Doc When did they view the Doc How many times they view the Doc
  12. 13. Detail Document Search
  13. 14. UR Modules <ul><li>Easy UR referral process </li></ul><ul><li>Tracking your UR cases </li></ul><ul><li>Standardized Queuing Systems </li></ul><ul><li>Zero Click Send Intaking </li></ul><ul><li>Automate UR results to CompIQ </li></ul>
  14. 17. Scanning Station Specs <ul><li>PC Attached With Minimum Memory Of 1 GB </li></ul><ul><li>Broadband Internet Access </li></ul><ul><li>Secure FTP Software(recommend CuteFTP) </li></ul><ul><li>Backup Scanner For Emergencies </li></ul><ul><ul><li>Printer, Copier, Other Low Cost Scanner(I.E. Fujitsu Snapscan </li></ul></ul><ul><li>Hard Copy Document Retention Policy </li></ul><ul><ul><li>7 to 30 Days Recommended </li></ul></ul><ul><li>Datacare Will Assist In Installation And Testing </li></ul>
  15. 18. Scanner Specification <ul><li>Scanner Features: </li></ul><ul><ul><li>Scan to File </li></ul></ul><ul><ul><li>Scan to PDF format </li></ul></ul><ul><ul><li>Automatic Color Detection </li></ul></ul><ul><ul><li>Intelligent Blank Page Detection </li></ul></ul><ul><ul><li>Separator Sheets Detection </li></ul></ul><ul><ul><li>Double Feed Detection </li></ul></ul><ul><ul><li>Duty Cycle up to 15,000 documents per day </li></ul></ul><ul><ul><li>Scanning Speed up to 1.1 seconds / page </li></ul></ul>
  16. 19. What Can DataCare Deliver <ul><li>Full Transparency of Claims </li></ul><ul><li>Accessibility of Claim Documents on real-time basis </li></ul><ul><li>Improved Efficiency by 20 - 50% </li></ul><ul><ul><li>Cut Cycle Time by 30 – 50% </li></ul></ul><ul><li>Fully Searchable Claim Documents </li></ul><ul><li>Business Continuity/Disaster Recovery </li></ul><ul><ul><li>Continuous Backup to Multiple Locations </li></ul></ul>
  17. 20. Summary <ul><li>Best reference in the world </li></ul><ul><li>Workflow built-in </li></ul><ul><li>Software as a service </li></ul><ul><li>Our Goal: To help all claim administrators to achieve improvement in claims handling efficiencies, time and cost savings </li></ul>

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