Automating Letter Template Generation

A CareRadius® case study

Client

A major health plan that provides quality care to 675,000 members for over 60 years.

Business case

Care management operations require a variety of letters to be sent to both, members and providers. In order to maintain regulatory compliance, letter generation must be accurate and free of complications. The client’s goal was to improve efficiency through automation of all care management workflow letters. 

Scope

The client’s business objectives, which had previously depended on the use of 371 templates for letter production, included:

  • Automation of letter generation for onsite and remote staff
  • Improved utilization of administrative staff
  • Simplification of letter selection for the end-user
  • Alignment/scheduling with mailroom operations
  • Use of faxing for urgent letters

Key Activities

  • Led creation and implementation of new letter strategy via consulting services
  • Performed letter-generation analysis to identify standard best-practice templates and reduce duplication
  • Transformed manual processes to completely automated workflow
  • Leveraged 3rd party vendors to provide tools to streamline letter delivery

The Results

Through the analysis of these letter templates, the client achieved the following improvements utilizing CareRadius®:

  • Reduced hundreds of letters to 89 files via an automated process involving the clients’ publishing/mail operation.
  • By associating letters to cases, improved auditing accuracy, which ensures that no letters are overlooked.
  • The remaining letters were condensed to 25 SAP® Crystal Reports® templates. These letters are selectable within CareRadius® for either faxing or manual printing for immediate mailing.
  • Of the 25 templates, 12 have triggers which prompt auto generation. If a user has already sent the letter, the trigger will not produce a duplicate.
  • The solution allows for flexible configuration of business requirements that change over time.
  • The CareRadius® Suite provided the client with a tool to implement an automated letter generation process and deliver value.

EXL Solution:

CareRadius®, EXL's cloud-based total population health platform. The CareRadius® integrates data from multiple sources for health plans and practitioners to enhance clinical decision-making, improve workflows and reduce administrative costs. CareAffiliate®integrates member data and connects remote providers to clinical staff, while streamlining care functions including authorization and referrals, inpatient admission notifications and program enrollment requests. Standard reports, such as the ODAG Organizational Determinations, Appeals and Grievances universe report, support clients' abilities to prepare and respond to CMS audits. Letters were added to meet CMS requirements for member and provider correspondence.

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