Provider Onboarding Automation

Provider on-boarding is a daunting task as it involves different groups in recruiting, approving and on boarding them. Average cost to recruit a provider increases by 50% over a period of 5 years and average time period to on board them is around 8 to 12 weeks.

A mobile enabled solution, which essentially brings about a reduction in on-boarding process time, thereby ensuring operational efficiency and customer satisfaction – which is the first step in retaining the customer. Templates are stored in Alfresco, Dynamic data is passed from BPM tool and document is generated dynamically & stored in ECM repository and a copy is shared with provider for Contract Agreement signature through DocuSign. The entire process is paperless and easy to manage at a faster speed.

Business Challenges

• Huge paper documents are generated related to claims, checks, benefits, contracts and negotiations.
• Departmental repositories in silos to store documents with lot of duplicate content.
• Lack of integration with enterprise applications in the area of claims processing, customer services, provider enrolment, enterprise reports, marketing campaign and customer facing portals.
• High cost incurred as Checks, explanation of benefits and predeterminations are extracted from legacy systems, printed, mailed and archived in different system.
• Multiple products to support, licenses and annual maintenance cost results in higher IT spend for storing and retrieving digital content.
• Unavailability of documents through online for speedy lookup results in lack of agility in changes to compliance requirements, limited innovation, and increased time to market.

Solution Overview

• To achieve the goal of “Paperless” effectively and to efficiently manage all communications, TechM proposed an initiative to consolidate existing departmental DMS systems and implement an Enterprise Content Management solution to meet the full-lifecycle of Content and Records Management needs across the enterprise.
• Implemented eDMS solution based on Alfresco for capturing, managing and storing electronic documents, compliance management with auto declaration and destruction of records across the enterprise level.
• Service based integration with Pega, Saleforce, Portals, and other enterprise applications
• The built-in workflow features allow document-intensive business processes to be implemented that helps to save time and money. The collaboration features enable secure collaboration, inside or across the firewall.
• The eDMS supports two user constituencies namely: internal and external. The internal users can access it directly by a browser or within the Enterprise Desktop application. External users only have access within the context of either the Portal or the Provider Tools portal
• The EDMS shall be used both internal and external user community to access documents across enterprise level. All the documents will be classified, apply appropriate tags, assign life cycle policy and destroy the document/records upon expiry.

How did the solution address the business problem?

• Consolidated disparate sources of content into a centralized EDMS repository to provide single source of truth.
• Automation of Provider on boarding process leading to reduced cycle time
• Providers are able to quickly search for documents containing specific information filtered by claim / account number.
• Integration with Enterprise systems (Pega, Salesforce) leading to enhanced process efficiency and faster cycle time.

Customer Benefits

• Time taken for Provider on boarding reduced from 3 months to less than 3 days.
• Around 1.2 million paper documents / per week prints have been reduced to 200k / a week
• 30% savings in license and maintenance cost.
• Eliminated redundant data entry and reduced group on-boarding timeline.