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Title
Occupational Health Management Company Dials Up Major Profits Processing
Workers Compensation
Client
NHR/Concentra- First
Notice Division,
a major national occupational health care management company, is
the nation's largest independent workers' compensation managed
care
company. First Notice Systems (a Concentra company) is the nation's
largest full-service claims reporting outsource service provider.
Their customers are leaders in the insurance industry.
Problem
The client wanted to extend its First Notice call centers to offer
a new for-fee service handling faxed workers compensation claims.
Claim volume can range from tens to many thousands per day and profitability
depends upon efficient processing of each claim.
Solution
inTouch designed and implemented a scalable server-based system
operated from an intuitive interface at the call center desktop.
The system collects faxes, sorts them by insurer, and enables human
review and linking of the claim form to its information in a legacy
claims management system. The processed claim documents are then
routed to the appropriate office at the insurer. Delivery occurs
by Internet, fax or both. The client also required 24x7 multiple-site
operation and multiple-scenario disaster recovery capabilities.
Benefits
NHR/Concentra enjoyed a rapid ROI with minimal business risk thanks
to inTouch’s pilot project approach combined with our efficient
design, expert deployment, and well-planned upgrade path. inTouch’s
design also resulted in an outsourcing solution that is completely
transparent to the insured. Claimants or their agents continue to
fax injury reports to the same 800 number they used before First
Notice began handling claims on behalf of the insurer. Total cost
of ownership is very low as the system is designed to run without
need of regular system administration, even continuing to operate
uninterrupted if disaster strikes any First Notice facility.
Details
Implementation was handled in two phases. First, inTouch deployed
a proof-of concept pilot system working with a key beta customers.
The successful pilot was then followed by a multi-site deployment
on fault tolerant servers. Failures at any layer (telco, PBX, hardware,
software, data-network or facility) can be detected and traffic
redirected to an alternate node. In addition to the technical design,
inTouch negotiated special arrangements with vendors to mitigate
NHR/Concentra’s upgrade risk.
To reduce
total cost of ownership, inTouch selected industry standard components
from approved vendors and performed integration with minimal custom
coding. inTouch also produced and delivered customized documentation
and training.
inTouch leveraged
its specialized understanding of computer and telephony integration
to produce a solution that flawlessly handles the identification
and separation of faxes destined for different insurers. The system
regularly handles over 25,000 pages of claims per day without a
single claim ever going to the wrong insurer.
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