California’s largest dental health plan is all smiles thanks to sub-second access to enrollee and provider documents.
Market leader goes big with Alfresco platform
Delta Dental of California (DDC) is the state's largest dental health plan with more than 25 million enrollees and 106,000 dentist locations. A member of the national Delta Dental Plans Association, the San Francisco-based company leads the market by limiting out-of-pocket costs and simplifying its claims process. Strategic investments in technologies like enterprise content management are critical to making DDC's dental plans affordable and easy to use.
DDC selected Hyland's Alfresco platform over IBM FileNet for its scalability, flexibility and easy upgrades. DDC has since integrated Alfresco platform into numerous business-critical processes, including:
- Claims processing
- Group sales, underwriting and enrollee onboarding
- Provider credentialing and onboarding
"Alfresco is a critical application for DDC for managing documents for enrollees, dentists and internal business applications," said Mahesh Kadarkarai, DDC's applications manager and architect.
Insurance is a high-volume, document-intensive business, especially when it comes to claims processing. In one year, DDC processed 29.4 million claims and generated 36 million claims-related documents — all of which are ingested and managed by Alfresco platform. DDC's 6 TB enterprise repository contains 318 million documents, with another 132,000 documents uploaded each weekday.
DDC uses Alfresco Content Services to improve the claims experience for patients and providers. Alfresco platform is integrated with DDC's Enrollee Portal so patients can easily look up explanation of benefits (EOB) statements and other claims information from a desktop or mobile device. Integration with DDC's Provider Portal allows dentists to submit claims and digital attachments online for faster adjudication and payment.
DDC has also connected Alfresco platform with its contact center application to enable prompt, responsive support and shorter call times. Customer service agents simply click a link to access Alfresco Share, where they can quickly retrieve documents while on the phone with patients and providers.
Alfresco delivers a sub-second response time, which allows us to quickly respond to customer requests. Our overall experience with Alfresco has been positive.
— Mahesh Kadarkarai, Applications Manager and Architect, Delta Dental of California
Sub-second response time
Performance at scale is imperative in DDC's demanding, high-volume environment.
"The first criteria for us is performance, which we've been able to achieve with Alfresco," Kadarkarai said.
In early implementations, DDC worked closely with the Hyland team to do performance testing and tuning. Now, Alfresco platform delivers a sub-second response time, which allows DDC to quickly respond to customer requests.
DDC leverages the platform's robust metadata support, indexing and search services to speed the retrieval of relevant documents. In the contact center, Alfresco platform's highly granular search capabilities allow agents to search by document category, document type, account number, customer name, zip code, date range and check number.
"We can further refine the search result by quantity, which is helpful when assisting large dental practices," said a DDC business support services manager.
Integration with Salesforce
DDC has modernized multiple content-rich processes by building solutions that combine Alfresco platform with other business applications.
"The ability for Alfresco to integrate with other systems is key for us," Kadarkarai said.
His team has taken advantage of the platform's CMIS REST API to accelerate solution development and make documents accessible from within the applications people use every day.
Integrating content and process
DDC has also integrated Alfresco platform with its existing BPM and case management platform to transform workflows in group underwriting and onboarding, as well as provider credentialing and onboarding.
"We've done a seamless integration with Pega," Kadarkarai said. There is a window for document lookup in the Pega interface, "but behind the scenes, it's really Alfresco," he added.
By integrating content and process, DDC can reduce the time required to approve and onboard new commercial accounts and dental practices, which is a huge benefit for a company that saw provider recruiting costs increase by 50% over five years. It's also easier to share documents across user groups — sales, underwriting, enrollment, billing, finance, etc.
More use cases on the horizon
DDC has been on a successful three-year journey with Alfresco platform. Looking ahead, Kadarkarai sees many more opportunities for document migration and integration. Projects on the roadmap include implementing it in DDC's individual line of business and integrating with Oracle E-Business Suite for greater operational efficiencies.
Kadarkarai said DDC's customers are happy, so he's happy.
"I couldn't think of anything but Alfresco for us now," he said.