Case Study: Process Automation Servicing Health Plans & PBMs

Small private company ($2M rev) Philadelphia, PA Health Care service company

Problem:

Company provides a service to health plans that requires a large daily volume of letters and faxes be sent to members, pharmacies, physician offices and regulatory agencies. The clients could modify the letters at any point, and the company did not have the programming staff to keep up with the letter template updates. The company also was using a significant amount of work hours to manually put together the letters and send them, which could be in the thousands per day. The company needed an automated solution that allowed them to service new clients without growing staff, as well as a way to update the templates that did not use the programming team’s limited time

 

Solution:

We created an automated software process that automatically tied into their application database to determine what orders were pending notification delivery, and which recipients were required for each order based on various conditions. The information for the letters was also pulled from the database so that the letters were dynamic. A scheduled process ran throughout the day, so that letters were printed and faxed on dynamic schedules based on the company’s clients’ preferences. Printed letters, including cover letters that folded and showed the address through the envelope slot, were generated and printed throughout the day. We worked directly with clients who had industrial printing capabilities in-house, to setup a secure delivery mechanism that sent the printed documents in merged PDF files for them to print at their location. Faxes were also generated and faxed using multiple fax vendors. A reporting process was setup that would query the vendors for the fax status, and alert both the company and the company’s clients when faxes failed to be sent. The templates were designed using Microsoft Word so that the company’s business analysts and even their clients could easily make changes to the templates as needed, and a secure template portal was designed to allow users to upload, test and replace templates on the fly.

 

Outcome:

After JB Consulting implemented our solution, the company was able to reduce the amount of staff dedicated to generating and processing notifications and faxes, and utilize them for other needs. The fax process was also improved now that failed fax reports were delivered in real time, so company personal could notify the physician’s office that a fax was unable to be sent, and work out an alternate delivery. The company’s clients were happier because they could edit their templates themselves if needed, and the turnaround time for the company to process template updates was improved significantly.

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Case Study: Process Automation Servicing Health Plans & PBMs
Small private company ($2M rev) | Philadelphia, PA | Health Care service company

Company provides a service to health plans that requires a large daily volume of letters and faxes be sent to members, pharmacies, physician offices and regulatory agencies. The clients could modify the letters at any point, and the company did not have the programming staff to keep up with the letter template updates.

Case Study: Prior Authorization Automation & EMR Integration
Private Company | Pittsburg, PA

We were approached by the owner of a digital health startup who wanted to design a product to improve and streamline the process for a doctor’s office to obtain prior authorizations (PA) from the insurance companies.

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