Sovereign Health, the largest healthcare administrator in KwaZulu-Natal, has become the first company in its market sector in South Africa to integrate document management and workflow into its existing IT environment. Sovereign Health is a wholly owned subsidiary of Medscheme. With more than 700 000 transactions processed a month, the integration of the company`s workflow systems into all business processes has dramatically reduced the physical paperwork wer processing.
Dave Carson, development manager at CCH Software Development, says the system designed for Sovereign Health is the only fully integrated medical aid administration system in the country.
"It was essential that the implementation of workflow was done in such a manner that the strengths of the integrated software system were not diminished in any manner and that the workflow solution is seamlessly integrated. Because of this, the workflow was custom-built into the system.
"Any correspondence that reaches Sovereign Health - mail, faxes, e-mail and telephone calls received at the call centre - are logged into the system. Physical documents are barcoded, scanned and logged into the system. All other inputs are automatically logged. From that point the workflow system routes documents throughout the organisation to be dealt with accordingly.
"We developed and integrated a sophisticated tracking system so that at all stages of the workflow, management can determine the precise location of any document, allocate resources to backlogged areas and deal with age analysis of documents. Reminders are sent to staff daily alerting them that certain items in their in-boxes need attention," says Carson.
Staff at CCH Software Development have been providing Sovereign Health with its IT requirements for the past 18 years, customising and tailoring applications to suit the healthcare administrator`s requirements.
Sovereign Health, recently acquired by Medscheme, has been striving towards the paperless office concept and this functionality has gone a long way to achieving this ideal.
"The first department we automated was the pharmacy benefit management department, ChroniCare Network (CCN); from there the solution was rolled out to include the integration of call centre, fax and e-mail activities," says Carson.
"The final phase of the rollover to workflow was completed late 1999. This phase involved the claims processing system, the most important and sensitive of the business processes.
"The claim lines per month exceed 600 000 and backlog situations can occur very quickly if problems arise. As a result, extensive training and testing were conducted before implementation. Until the workflow and document management was implemented for claims, claim accounts were scanned on microfiche and retrieval was a slow process that could often take over a day. Medical and fraud investigations were slow and cumbersome as were call enquiries where original documentation was required.
"For the implementation no major hitches were experienced and the staff reported immediate benefit. For example, a call centre clerk can now retrieve original documentation direct from the desktop without having to leave their desk and members telephoning in can obtain immediate confirmation as to whether their account has been received."
Carson says that without doubt the most successful area was the claims assessing division because of its sheer size and complexity.
The solution designed and developed by CCH Software Development is based on an integrated medical aid solution using a 40GB Oracle database with 120GB imaging storage. Application development was done in the Oracle Forms 5 and Reports 3 languages while RightFax, Java, C++ and Perl were used to develop and integrate the functionality for retrieving documents, and capturing e-mails and faxes.
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