| The most common transactions for today's insurers | | | | items to the appropriate person at the next step in |
| are patient-related matters regarding membership, | | | | the business process. If supplemental documentation |
| benefits, pre-authorizations and claim payment, | | | | is received at a later date, the solution automatically |
| maintenance-related issues and long-duration case | | | | matches it with the existing work in progress. |
| management. Extensive documentation is associated | | | | The solutions extensive case management capabilities |
| with each of these transactions and often manual, | | | | also present credentialing personnel with a single |
| paper-based business processes. This causes | | | | electronic case file contain all associated documents, |
| processing delays, inefficiencies and inaccuracies and | | | | extensive data from administrative and other |
| increased administrative costs. | | | | business systems along with task guidance and |
| Manual business processes prevents universal access | | | | process management features. This not only |
| to case-related documents, preventing effective | | | | eliminates manual case assembly, searching and |
| first-call issue resolution. Additionally, transactions | | | | sorting, it also simplifies reviews by providing |
| subject to regulatory compliance mandates cannot be | | | | navigation to all pertinent information and consolidates |
| managed as organization records. | | | | decision-making data into easy to use interfaces |
| Insurers needs comprehensive solutions that enable | | | | specific to each step in the credentialing process. |
| them to expedite provider transactions by supporting | | | | Additionally, process management features automate |
| timely and consistent workload management. | | | | credentialing assignment, create task reminders and |
| Business process automation solutions can reduce | | | | generate needed follow-up activities. |
| costs and improve efficiency as well as achieve high | | | | When provider documentation must comply with |
| levels of first-call resolution by supplying personnel | | | | regulation such as Sarbanes-Oxley, the application |
| with the information needed to respond immediately | | | | invokes its records management capabilities. The |
| to provider inquires. Additionally, insurers must also be | | | | solution supplies efficient capabilities for answering |
| able to comply with increasingly stringent and | | | | routine provider request immediately and also |
| wide-reaching regulations and requirements for | | | | resolving complied requests rapidly an accurately. |
| managing organization records. | | | | Ultimately, it replaces paper-driven processes with |
| With this type of software, transactions received by | | | | more efficient content and process automation. |
| paper, fax, email or via self-service portals are | | | | These interfaces increase productivity and accuracy |
| captured, cataloged and stored in a content | | | | by allowing provider relations representatives to work |
| management repository. Provider transactions are | | | | within a single, consolidated view. This enables them |
| managed, which offers a single secure interface for | | | | easy access to all of the information available in order |
| documents, host system data and task completion. | | | | to process insurance transactions, as well as the |
| Configurable business rules automate work | | | | ability to view tasks in the order in which they must |
| distribution, creating and dispensing electronic work | | | | be fulfilled. |