Automation replaces risky manual processes and ensures both compliance and member satisfaction remain intact
One of the country’s largest Managed Care Organizations (MCO) has an extensive portfolio of coverage options. However, they lacked an automated workflow process to handle replacement materials requests from members. These members had either lost or never received ID cards, welcome kits, or annual notices of change (ANOCs).
The MCO’s customer service team was manually keying in member information while sifting through lists of replacement items. This process was dragging down productivity and profitability, and creating issues with Medicaid and Medicare audit and compliance requirements. It was also negatively impacting member satisfaction.
The RRD Healthcare Solutions team collaborated with the client’s customer service, marketing operations, and compliance teams. RRD recommended the CustomPoint® end-to-end print management solution. CustomPoint would centralize ordering, fulfillment, content customization, and direct mail campaign management all through a single interface.
The solution met the need of all teams involved:
- An easy-to-use system for over 1,400 representatives for customer service
- Brand standards consistency maintained across the MCO’s 13 different brands for marketing
- Accuracy and improved turnaround times for operations
- Fewer keystrokes resulting in fewer reporting errors for compliance
The CustomPoint solution easily integrated with the client’s existing customer service platform, streamlining, and optimizing ordering. It helped create extensive business rules around attributes like group numbers, contract numbers, and plan years. Customer service reps could quickly pinpoint the right materials for member requests.
Central to any health plan’s success is the protection of personal health information. RRD’s deep experience in this category provided:
- Secure FTPs for data transfer
- Encryption during transmission
- The highest levels of data security at healthcare printing and fulfillment facilities
CustomPoint also gave the client the visibility and tracking they needed for CMS and turnaround time compliance. CMS audits were directly integrated into their senior reporting center.
The client gained the flexibility to respond to member requests that came in before the in-home compliance due date. Some finalized documents had not even been loaded, particularly large print, foreign language, and 508-compliant alternate versions. With the CustomPoint solution, customer service representatives could place orders for these materials when requested.
RRD Healthcare Solutions and CustomPoint have helped the client expand their library from 500 to over 1,800 items. New additions include Spanish, Vietnamese, Chinese, and Korean versions of English-language replacement materials. Large print, Braille, audio, and 508-compliant versions were added too.
Automating their member replacement materials ordering process has eliminated missed or incorrect orders. The CustomPoint solution also helps to provide consistency of brand standards. It provides greater transparency into member orders, including frequency and turnaround times that are critical compliance metrics.
Continual optimization and improvement are always top of mind. Planned enhancements include features like single sign-on to further reduce keystrokes and supporting client efforts for even greater electronic file delivery efficiency.