Managing Managed Care Made Easy with Vasion’s Digital Automation

CHALLENGES

• Complicated claim intake processes.
• Security concerns.
• Confusing workflows and processes for end users.

RESULTS

• Streamlined digital claims workflow automatically verifies and processes claims.
• Information is secured, validated, and stored for easy retrieval.
• The intuitive interface makes navigating easy for end users and lowers IT overhead costs with simple no-code configuration for administrators.

Orthonet Needed a Digital Upgrade

OrthoNet is the leading orthopedic specialty benefit management company in the United States. Headquartered in White Plains, NY, with offices in California and Florida, OrthoNet’s innovative care management model integrates the needs of providers, payors, and members to ensure the delivery of high-quality, cost-effective care while realizing substantial savings that keep the costs of healthcare down. Ensuring that crucial information can be found rapidly, and claims are processed quickly, is a key component to their success.

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OrthoNet’s customers include health maintenance organizations, medical groups, IPAs, indemnity insurers, preferred provider organizations, managed-care organizations, workers’ compensation insurers, and other payors. In order to help doctors deliver the best care possible and spend more time with their patients, Orthonet decided their existing file processing and document delivery system required a shot in the arm. OrthoNet needed a system that could automate the sorting and delivery of documents to enhance customer service and improve the bottom line. Because it met these key requirements, Vasion was chosen as the solution to digitize and automate OrthoNet’s claims processing operations workflow.

Thousands of New Documents Must Be Identified, Filed, and Routed Per Day

Every day, insurance claims arrive via fax from any of the 80,000 orthopedic health care providers OrthoNet supports. Vasion processes the documents, recognizing patient as well as healthcare provider identification numbers and matching them against the database. If the patient and provider are already in the OrthoNet system, the rest of the index information is automatically filled in. If they do not match, the documents are routed to the contract assistant who verifies that the information was captured accurately and either makes necessary corrections or enters the new patient information into the OrthoNet business system.

Once indexed, Vasion links the documents to open case files or creates a new case file if one does not already exist. The processing workflow is then triggered, and the responsible contract manager is notified that new data has arrived and is ready for action. Contract managers, doctors, and other users included in the workflow have options to complete their step, send the document back, re-assign it to another user (or user group), or to forward the document to someone outside the workflow for clarification. At all times throughout the workflow process, the documents are accessible to the customer service agents who need to answer inquiries from patients and/or
providers. Once the claim has been processed and the case is closed, the documents move to the archive where they are locked as read-only records.

Vasion Helps Orthonet Exceed Expectations

Documents are now sorted and indexed, while data is processed faster and more accessible than ever before. The need for paper copies is almost completely eliminated, saving time and improving efficiency across all levels of the workflow. Supporting data and documents added to an open case can quickly be linked to the primary document with a simple click. Because of these improvements, contract managers can get work done faster, process more claims, and keep tabs on documents they have sent to doctors for review. Additionally, Vasion provides peace of mind for the OrthoNet IT support team. Because the administration of Vasion is so simple and intuitive, the OrthoNet IT team does not have to rely on specialists to make any adjustments to the system.

With Vasion in place, OrthoNet’s communication with their network of health care customers has become faster, more efficient, more accurate, and less expensive.

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And as OrthoNet grows, Vasion seamlessly scales to address expanded applications and subsequent increases in workflow.

Partnering Up for Results

With Vasion, OrthoNet is now able to sort, index and process crucial medical benefit documents faster and with less manual intervention than ever before. Ease of use, customer service and the bottom line have all trended upward. The new digital workflow has virtually eliminated paper copies while introducing more efficiency and flexibility.