SoftCo, a trusted solutions partner for Vhi Healthcare for more than a decade, assisted Vhi Healthcare in eliminating manual procedures, reducing the risk of error that is found in its large paper based administrations and reducing its claims processing times. SoftCo also provides on-demand access for healthcare providers to their scanned claims for faster resolution of queries.
Most health insurers today confront similar problems of managing accurate information flows, ensuring correct and timely claim processing and reducing the administrative burden of the claims procedure. In addition it is imperative to provide excellent customer service to ensure claim queries are answered efficiently and all supporting documentation is readily available. Vhi Healthcare has leveraged SoftCo’s expertise in healthcare revenue cycle processing to deliver radical improvements in its claim handling processes.
“One of our key challenges was to prioritise claims that were older or larger in value and to provide full visibility around them”, explained Mark Byrne, Claims Manager, Vhi Healthcare. “When improving and delivering efficiencies into our systems and processes, we worked closely with SoftCo to design an approach which met our needs and delivered a superior level of service to our customers.”
All claims from hospitals and primary care units are now automatically directed to SoftCo’s secure Managed Services facility. While the majority of incoming claims are still paper based, SoftCo also provide electronic claim submission solutions as more hospitals move towards electronic claim processing. This hybrid approach is essential as a proportion of the claim documentation will continue to be paper based for the foreseeable future.
A number of important control validations are undertaken to ensure the accuracy and completeness of the submitted claims which are then scanned to create an electronic claim pack for Vhi Healthcare. All claim data and supporting documentation is electronically uploaded into the Vhi Healthcare claims processing system on the same day as the original claim was received by SoftCo.
According to Mark Byrne the SoftCo process has delivered real benefits, “Not only do we get the documents faster, we are also able to integrate seamlessly with our Inpatient Adjudication System (IAS) and process claims on a prioritised basis”.
All claims are automatically archived into the SoftCo R8 system at Vhi which ensures full audit compliance and is directly integrated with the Vhi Healthcare claims processing systems to provide instant access to all claims information and supporting documentation.
Hospitals can access a secure cloud based online portal to view any of their submitted claims documentation on demand which helps expedite query resolution. The SoftCo portal, FormsAccess, also allows Vhi Healthcare’s providers to validate that their completed claims have been received by the company.
Mark Byrne, Claims Manager for Vhi Healthcare, says the reliability and efficiency of the SoftCo service allows his team to focus on their primary goal, working together for the well being of our customers.
“SoftCo has worked closely with us as we continuously improve our claims management processes and reduce turnaround times,” said Mark. “SoftCo really understand the environment we and the hospitals are working in and that makes all the difference as we continue to make our business more efficient. They have always delivered a high level of service.”
Mark Byrne Claims Manager, Vhi Healthcare