Provider enrollment

Client

Our client is a large Medicare Administrative Contractor.

Challenge

Our client was performing at a rate 70% below the desired gold standard objectives for Provider Enrollment and needed to leverage their investment in Hyland OnBase software platform.

Background

This MAC asked EXL Consulting to provide a transformational roadmap to carve the path to achieving gold standard performance for Provider Enrollment. EXL Consulting worked with executive management and subject matter experts to shape a vision to address immediate needs and support strategic planning.

EXL consulting solution

EXL Consulting’s process assessment consisted of subject matter expert interviews, process shadowing and modeling and examining existing documentation. Partnering with the client’s business excellence team, EXL Consulting established metrics to time current processes and identified target improvement areas. The output was a published phased roadmap tailored to provide for quick (trust building) wins and more strategic improvements for longer term sustainability and scalability.

The productivity rates have continued to trend upward through our phased implementation of the project despite a significant change to the business operations.

Results

  • Within the first 6 months, the productivity rates have increased over  50%
  • and are projected to  approach 2x
  • Continued talks are in place to extend the partnership with visibility to increase productivity by 3x

Improving provider enrollment

Phase 1: Building off the BluePRINTTM, EXL lead delivery and demonstration of OnBase and the ability to generate results. The solution focused on workload management, building on an existing application to eliminate manual work.

Phase 2: This phase took an aggressive goal and delivered a new workflow to replace the client’s current application. Leveraging the workload management code introduced in Phase 1, a new, dynamic eForm user interface was introduced to enhance the Provider Enrollment’s front line operations, facilitating document indexing and tracking.

Phase 3: Currently in progress, this phase is introducing advanced workflow and system automation including auto-mated work creation and in-dexing, letter generation and submission, and systematic workflow monitoring using timers to act on and progress work according to established business rules.
 

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