All Healthcare insurers public or private are challenged with controlling administrative costs, complying with legislation, managing the timeliness of claims processing and improving provider relationships while providing superior care and service to plan members. On the other side is the Provider community dealing with most of the same issues controlling administrative costs, complying with legislation, providing superior care and service to patients and maintaining accounts receivables to stay in business. In light of all the on-going discussions, whether it is new HIPAA regulations or Healthcare Reform, organizations are seeking ways to meet the challenges of improving health care quality through technology and data access.
Organizations have a variety of requirements for medical record management but they focus on a core group of needs, including:

• Accurate payment of claims
• Compliance with HIPAA, local and federal regulations
• Privacy and Security
• Timeliness
• Content Management and Retention
• EDI compliance
• Efficient routing of medical records information from one department or organization to another
• Reporting

These needs typically span the IT infrastructure including document imaging - enterprise content management (ECM), claims and attachment automation - business process management (BPM), framework integration, third-party connectivity – Fax, Email, FTP, XML Web Services, EDI, Message Queuing, and contextual collaboration.

Sample Healthcare and Insurance ECM Projects:

• Claims: Automation of FEP process
• EDI: Continuous improvement of electronic transactions
• Medical Management: Automation via Web, IVR and Fax of Authorizations, Referrals, Pre-certifications and Notifications
• Pharmacy Management: Prior Authorization Automation
• Membership: Automation of Enrollment process
• Application Migration: BPM Application Migration from Legacy System
• Claims Processing: Misrouted Claims and Claim Attachments Processing
• Case Management Solution for Content-driven applications in Healthcare>>