NIB gets Healthsmart for claims

Health fund NIB has signed a five year contract to outsource their manual back office activities and automate the processing of high volume paper transactions to a partnership between Salmat, Civica and Dataract.

Previously more than 600,000 transactions per annum were handled annually by NIB and manually processed.

HealthStream was established in 2008 to target the growing market for claims and transaction processing for Australia's 40 private health funds.

Business Manager Peter Lavender said the NIB contract was signed on 30th June 2009 and the solution went live on 19th October. Conversion to digital capture will occur progressively in stages of a 24 month timeframe.

"This is an industry play," said Lavender. "We we aim to capture the private health insurance industry with a solution for all claims and high volume transactions that cannot be delivered by EDI (electronic data interchange)." We see HealthStream as the 3rd automated channel alongside Hicaps and Eclipse.

The private health insurance industry in Australia is at varying stages of adopting digital workflow, with many funds still reliant on paper processing and manual data entry.

"HealthStream is a unique offering that combines three complementary organisations offering technologies that cover the end-to-end process from the mailroom through to back end system processing," said Lavender."

The NIB digital solution begins with scanning of forms at a facility established especially for NIB at Salmat in Mayfield West, a suburb of Newcastle, NSW.

An OPEX scanner will be used for the extraction and scanning of all standard size envelopes. The model used will be the AS3690i Digital Mailroom Solution. This scanner delivers an integrated solution which includes envelope opening, in line preparation, duplex colour scanning, document classification and output sorting – all delivered with a single operator.

Kodak Scanners will be used for the scanning of items from large envelopes and Express Post satchels. The Kodak Scanners to be used will be the i260/280 models which are currently used by NIB.
The scanned forms are then transferred to the Sydney Salmat facility via a high speed link for OCR/ICR using Kofax and in-house software.

All health claims must be submitted manually with a 'wet' signature, which is electronically checked against the ‘wet’ date alongside it for presence. Indexes, such as customer and provider numbers, are validated against NIB data.

Dataract provides its e5 Workflow software as a hosted solution for managing and delivering all human interactions, such as exceptions and QA, during both the processing and the enquiry phases of the process.

Civica provides the Straight Through Processing interfaces to its fund administration application which is used by NIB and three other of the top six private health funds in Australia. For those that don't use Civica, HealthStream is able to provide interfaces to other administration systems using, where possible industry standard formats such as Eclipse and Hicaps.

The HEALTHStream solution incorporates imaging, document management, fax management, e-mail management, outbound document production, document archiving, workflow, straight through processing, statistical reporting and business activity monitoring.

According to CEO, Mark Fitzgibbon, the HealthStream solution, developed specifically for the health insurance industry, will deliver greater automation across claims administrative services at NIB, as well as enhance the customer experience.

“The HealthStream solution will reduce the costs of routine claims processing and policy administration by an average of 30 percent over the next two years,” Mr Fitzgibbon said.

“The change will also lead to savings in operational costs through the reduction of manual handing of high volume transactions. This greater efficiency will reduce operational costs and also free our employees to work on strategic business imperatives in the claims and policy administration area,” Mr Fitzgibbon added.

The HealthStream services will be used by NIB on a pay-per-transaction model, and therefore does not represent an up-front capital investment and hence risk.