Background: The Enrollment Services division of an Equian client launched an initiative to enhance their existing processes for soliciting, obtaining and updating COB information within their systems. At that time, the client required completion of a three-page questionnaire to ascertain if members had additional insurance policies. Our client realized this method was both outdated and cumbersome for their members. In addition, it lacked the automation and reporting capabilities they desired.
Our client approached the development of their new COB process holistically. They scrutinized each touch point in the process and incorporated member feedback to identify areas needing improvement.
Developing a Distinctive Solution: Our client recognized that establishing primacy up-front would significantly streamline their COB claims processing. They sought a cost-effective, innovative way to collect and record coverage information from their members at three key membership stages: enrollment, annual renewal and point of claim.
While Equian offers a comprehensive suite of recovery solutions, our client was specifically interested in exploring how our sophisticated customer service processes could be integrated with their existing systems and vendor relationships. Equian worked in partnership with the client and their other outsourced vendors to develop an entirely new front-end COB product.
An Integrated Approach: In the new scenario, the client replaced their three-page questionnaire with a one page letter directing members to call in to a toll-free number. These calls route into a sophisticated interactive voice response (IVR) system and guide members through a coverage verification process.
If a member indicates having other insurance, the IVR automatically transfers the call to a specific Customer Service unit at Equian. These “warm” transfers include a unique identification system which transmits the caller’s membership information to Equian along with the call. This process saves time and inconvenience for the caller as the CSR at Equian already has their membership information.
Equian’s CSRs enter information regarding other insurance carriers directly into the client’s claim system, significantly streamlining the data entry process. Additionally, all calls are recorded and retained for at least 30 days to ensure quality and resolve any miscommunications.
The flexibility of Equian’s Troveris® software platform allowed for an alignment with our client’s internal customer service initiative of only speaking with the patient or patient’s designated, authorized or personal representative. This integration allows Equian to take the call rather than turn the caller away if they are not the actual patient.
Results: This innovative solution addressed our client’s strategic objectives in developing a state-of-the-art COB process. Since implementing the integrated front-end COB process, our client has realized an average annual increase of 10-15% in their COB solicitation response rate. In addition, direct member feedback to the client indicates a very positive member experience.