Ultera/P8 for Network and Provider Relations

Business Challenge
The most common transactions for today’s insurers are patient-related matters regarding membership, benefits, pre-authorizations and claim payments; maintenance-related issues concerning the provider’s practice; and, long-duration case management, including contracts and credentialing. Extensive documentation associated with these transactions and manual, paperbased business processes, causes processing delays, inefficiencies and inaccuracies and increased administrative costs.

Manual business processes prevents universal access to case-related documents, preventing effective first-call issue resolution. Additionally, transactions subject to regulatory compliance mandates cannot be managed as organizational records.

Insurers need comprehensive solutions that enable them to expedite provider transactions by supporting timely and consistent workload management; reduce costs and improve efficiency; and achieve high levels of first-call resolution by supplying personnel with the information needed to respond immediately to provider inquiries. Additionally, insurers must also be able to comply with increasingly stringent and wide-reaching regulations and requirements for managing organizational records.

Solution
With IPD’s Ultera/P8 for Network and Provider Relations, transactions received by paper, fax, e-mail or via selfservice portals are captured, cataloged and stored in an IBM Enterprise Content Management (ECM) repository. Provider transactions are managed within Ultera/ P8 for Network and Provider Relations, which offers a single secure interface for documents, host system data and task completion. Configurable business rules automate work distribution, creating and dispensing electronic work items to the appropriate person at the next step in the business process. If supplemental documentation is received at a later date, the solution automatically matches it with the existing work in progress.

The solution’s extensive case management capabilities also present credentialing personnel with a single electronic case file containing all associated documents, extensive data from administrative and other business systems along with task guidance and process management features. This not only eliminates manual case assembly, searching and sorting, it also simplifies reviews by providing navigation to all pertinent information and consolidates decision-making data into easy-to-use interfaces specific to each step in the credentialing process. Additionally, Ultera/P8 for Network and Provider Relations process management features automate credentialing assignments, create task reminders and generate needed follow-up activities.

When provider documentation must comply with regulations such as SarbanesOxley, Ultera/P8 for Network and Provider Relations invokes its records management capabilities. The solution supplies efficient capabilities for answering routine provider requests immediately and also has case management capabilities for resolving complex requests rapidly and accurately. Ultimately, it replaces paper-driven processes with more efficient content and process automation.

Value Proposition
Designed and built by insurance industry experts and based on real-world customer requirements, Ultera/P8 for Network and Provider Relations is scalable from the smallest to largest numbers of users across geographically dispersed operations, offering insurance-specific capabilities to improve performance, reduce costs and efficiently resolve case files. The solution streamlines network and provider relations by ensuring that customer requests are responded to in a timely manner, delivering a significant competitive advantage, and lowering risk via process consistency.

Ultera/P8 for Network and Provider Relations interfaces increase productivity and accuracy by allowing provider relations representatives to work within a single, consolidated view. This enables them easy access to all of the information available and needed in order to process insurance transactions, and the ability to view tasks in the order in which they must be fulfilled.

Ultera/P8 for Network and Provider Relations delivers a low total cost of ownership and a compelling return on investment, with payback in less than 12 months. In addition, IPD clients report dramatic performance improvements and business returns, including cycle time reductions of 50 percent or more, productivity increases of better than 45 percent, and processing cost reductions exceeding 40 percent, with assured compliance, and within a fully configurable solution that is often deployed across most of the core operational areas of insurance organizations.