0988_INS_Healthcare Macess Dakotacare_Case study_V2.indd

Insurance Case Study
DAKOTACARE AND MACESS
Overhaul Claims Processing – Dakotacare Pays
Claims Faster by Automating and Streamlining
Processes with FIS
Overview
Challenge
Founded in 1986, physician-owned DAKOTACARE is the
Health Care Plan of the South Dakota Medical Association.
● To improve operational efficiency, DAKOTACARE
sought to further automate its claims processes.
DAKOTACARE and its subsidiaries serve over 122,000
members in South Dakota and across the nation. A FIS
customer for 13 years, DAKOTACARE recently made the
switch from iMax to Macess, a process and content
management system for health insurance plans.
● The Plan sought to clear and pay pended claims
more quickly.
The result: improved efficiency, happy customers and
more satisfied employees.
My five year plan is to get
Macess workflow into every
department in the company.
ROY NEWCOMB, DIRECTOR OF
INFORMATION TECHNOLOGY,
DAKOTACARE.
● DAKOTACARE needed an efficient way to track and
monitor claims at any stage of the workflow.
● DAKOTACARE needed a secure and efficient way to
document and track calls and correspondence from
clients, members and providers.
Solution
● DAKOTACARE converted to Macess to improve
automation across claims processing.
● Process Director was employed for greater rules
configuration and the ability to script information and
alerts calls to the host system.
● Contact Service Forms enabled capture of every member
and provider call.
● Utilized Macess integration to enable immediate access
to member information from the host system, flagging
members needing special attention.
● Macess Reporting enabled end-to-end automated
tracking of claims.
Dakotacare and Macess
Result
●● Pended claims are being paid 16 percent faster since
the upgrade.
●● Multiple pended claim issues can be worked
simultaneously and are automatically assigned
to the right processor at the right time.
●● Near real-time claims adjudication has been achieved,
significantly increasing efficiency and reducing
turn-around times.
●● Scripting has enabled the plan to flag members as
needed, automatically sending them to the right
processor or manager.
●● Direct updates of member files within Macess have
improved efficiency by pushing edits directly to the
host system.
●● Processors are managed more efficiently due
to automated reporting of processed claims.
FIS really set us up to succeed,
walking us through every step and
mapping things out. I can’t imagine
our conversion to Macess going any
smoother, due in no small part to
the excellent team that FIS sent out to
guide us through this process.
About FIS’ Healthcare Solutions
FIS has been helping healthcare payers succeed for more than
twenty years. Our award-winning Macess and FormWorks
solutions are trusted in a wide range of operational areas
including claims, member/provider service, enrollment,
appeals, authorizations, contracting, marketing, legal and
many others. Healthcare payers also depend on FIS’ Financials
solutions for comprehensive accounting and reporting to meet
ever-changing regulatory demands. Our healthcare payer
clients cover the spectrum of size and specialty from managed
care to indemnity, individual and group products, from fully
funded to TPA financial models. With hundreds of healthcare
implementations, FIS complements core platforms from other
third-party vendors and enhances home-grown applications.
About FIS
FIS is a global leader in financial services technology, with
a focus on retail and institutional banking, payments, asset
and wealth management, risk and compliance, consulting
and outsourcing solutions. Through the depth and breadth
of our solutions portfolio, global capabilities and domain
expertise, FIS serves more than 20,000 clients in over 130
countries. Headquartered in Jacksonville, Florida, FIS
employs more than 55,000 people worldwide and holds
leadership positions in payment processing, financial
software and banking solutions. Providing software, services
and outsourcing of the technology that empowers the
financial world, FIS is a Fortune 500 company and is
a member of Standard & Poor’s 500® Index. For more
information about FIS, visit www.fisglobal.com
ROY NEWCOMB,
DIRECTOR OF INFORMATION
TECHNOLOGY, DAKOTACARE.
www.fisglobal.com
twitter.com/fisglobal
[email protected]
linkedin.com/company/fisglobal
©2016 FIS
FIS and the FIS logo are trademarks or registered trademarks of FIS or its subsidiaries in the U.S. and/or other countries.
Other parties’ marks are the property of their respective owners.
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