A Large Healthcare Provider Streamlines Case Management

The Challenge

The organization needed to automate the consolidation and output of claims documents, invoices, statements and other documents that were critical to effcient case management. Since multiple clinics and applications fed into their claims processing system, multiple formats needed to be converted and standardized for output.

Their goal was to fnd an off-the-shelf enterprise-class solution that ft into their current enterprise environment, could be easily extended for their requirements, and would address the multiple use cases that their network of clinics managed.

The Solution

CrawfordTech implemented Riptide Server®, an integrated output management solution that enhances and extends ECM platforms. With Riptide, data within their ECM system can easily be collected, converted to the desired output format for fax, email or print, and automatically distributed and output. Using the RESTful API, the CrawfordTech services team assisted in integrating Riptide into the IBM Case Manager environment.

One of the primary benefts of Riptide is that it is highly confgurable so that it can function in virtually any environment to integrate with automated workfows and simplify case management. To meet this customer’s needs, the combined solution was implemented so that when a request is made for a patient record, the system queries the repository, and pulls and displays the relevant records from IBM Case Manager. The appropriate documents that are needed to fulfl the request are selected, downloaded and displayed for review. The fnal content is then converted to PDF as needed, combined into a single bundle, cleaned up, with information such as a table of contents, watermarks, notes and other specifc bundle data selectively added. The bundles are then created and output, with all activity logged in the Case Manager repository and available for auditing of the process.

The Results

The healthcare organization now has a tightly integrated solution that has automated patient records and document management and output as part of their case business processes. As a result, they are able to handle claims more effciently, reducing error, reducing time with billing cycles, and streamlining administrative processes.