CHALLENGE

Our client has identified a need to add Employer Self Service features to their Employer Connection portal. The features encompass the following items:

• Manage Activation
• Maintain Access Rights
• Employer Registration and Login
• Maintain Employer
• Employer Group Roster
• Self-Service Transactions
  • Add Member
  • Update Member
  • Terminate Member

OUR SOLUTION

In the first project phase Vicert put together a technical architecture document for the requested solution that detailed out the complete system design.

In the second project phase Vicert implemented this solution by developing three major subsystems of the portal:

• Security - Proving all functionalities related to the user administration and maintaining access rights like activation, registration, login and delegation.
  
  
• Employer Group Roster - Providing an ability to view the employee roster online displaying current employees as well as historical data. The system enables users to search, sort and print their roster.
  
  
• Self-Service Transactions - providing an ability to initiate a transaction to conduct add, changes, deletes for employees within an employer group.

BENEFITS TO THE CLIENT

• Vicert helped architect the client's first major solution on the new Spring/Hibernate software platform.
  
  
• The client gained greatly improved features and quality of online self-service capabilities available to the employers and producers/brokers.
  
  
• The new solution satisfied the critical need of employers to validate eligibility and benefits online for the group members, since the client's old employer portal did not support this functionality.
  
  
• The new portal, aside from serving as registration and login point, also provides the single sign-on capability for the users to navigate to other employer-related applications, both those hosted internally and those hosted by external ASPs.

CHALLENGE

Our client identified a need to build the online Provider Portal system enabling medical providers to check members' eligibility, get detailed benefit information and perform claim status inquiries 24x7, every day of the year. The required eligibility, benefits and claim status information are stored on four independent systems:

• NASCO (National accounts claims and membership systems)
• RTMS (Commercial accounts membership system)
• TPSU (Commercial accounts claims processing system)
• Blue Exchange, the data management system shared between the Blue Cross and Blue Shield plans around the country

OUR SOLUTION

In the first project phase Vicert put together a technical architecture document for the requested solution and, after the client approved this proposal, prepared a set of documents that detailed out a complete system design. In the second project phase Vicert implemented this solution by developing three major subsystems of the portal:

• XML API framework that performs necessary business logic and acts as a content provider exposing all of its features and capabilities through Web Services.
• Provider Transaction application, a web application that provides an interface to medical providers and uses XML API as a content provider.
• MTM Auditing and Reporting application providing complete tracking of all activities in the API to be used in reporting and auditing of transactions and overall monitoring of the system usage.

BENEFITS TO THE CLIENT

• Helped architect the middleware components.
• Short time to architect and implement core feature set (5 months).
• Phased approach delivered customizable solution that following projects are already using.
• Cost benefits: 5 to 10x.
• " Greatly improved features and quality of online, self-service capabilities available to the medical providers.

CHALLENGE

The primary challenge our client wanted to address was replacing the mostly manual process of handling various maintenance requests with a web-based tool.

The process involved receiving, triaging, batching and printing faxes, emails and paper request. Those requests were then moved around in paper form between various functional groups that are responsible for the processing of the requests.

Our client also wanted to enhance tracking and reporting capability for all maintenance requests.

OUR SOLUTION

Vicert produced a web-based tool that brought the following:

• A single data source - all requests (faxes, emails and paper request) are stored in electronic form, in one place,
• Automation of the workflow. Triaging and routing of requests is based on the clearly defined set of business rules,
• Automatic tracking where each request is located, at any moment in time, and who is responsible for its processing,
• Outbound fax and email communication to other employees or producers,
• The management is enabled to do analysis and reporting on the workflow,
• The time for each task is shortened, accuracy and consistency increased while the data integrity is preserved.

BENEFITS TO THE CLIENT

Administrative and production costs are lowered by:

• Replacing the currently used process of receiving, triaging, batching and printing faxes, emails and paper request,
• Eliminating the need to keep paper requests for number of years,
• Eliminating the use of tracking database in MS Access,
• Eliminating the possibility of request being not processed or lost,
• Eliminating the manual hand-offs of paper requests between functional groups.

The tool has also improved output quality and customer satisfaction by:

• Significantly reducing the time to process each request,
• Improving the perception of the client's request-handling capabilities,
• Driving performance levels to exceed competitive benchmarks,
• Implementing performance measurement and tracking.

HFCA - Hospital Facilities Contracting Application

Streamlining contracting process into one easily accessible online location

CHALLENGE

Our client identified a need to build an online contract management application based on the existing Access modules. The purpose of this application is to be a single-source processing aid for the facility claim processors and to replace a need to review and interpret complicated hospital contracts in a series of complex and only partially automated steps.

OUR SOLUTION

Vicert prepared a detailed system design that included a complete functional prototype that enabled the BSC team to further analyze business process modeling within the application

Using the prototype as a starting point, Vicert developed the application that centralizes every aspect of the contracting process into one easily accessible, online location.

BENEFITS TO THE CLIENT

The application streamlines contracting process, making operations of the human resources more efficient, thus reducing the organization's workload for contractors and approvers.

Retrieving, storing, and maintaining all the hospital contracts in various locations is now less time consuming and more efficient.

Eliminated issues with multiple users in Access application increase productivity for the client.

CHALLENGE

Our client identified a need to provide thier community and membership with indexed action-oriented web content, tools and resources for self-care and condition self-management.

After a detailed vendor assessment, Healthwise was selected as the vendor of choice. Healthwise is widely considered to be the gold standard in health content.

The client's contract with the Mayo Clinic was ending and new vendor contents needed to be integrated in to the site by end of the contract.

OUR SOLUTION

We developed a sophisticated presentation layer for XML to HTML content conversion with an emphasis on the speed of processing.

Vicert implemented the process for Healthwise data collection, accommodated this content to client's existing data structure, and implemented the appropriate presentation layer to allow browsing of the content.

BENEFITS TO THE CLIENT

Our client is now able to offer its members, prospects and site visitors the "best in class" health content and to do that with added efficiency to the health content management process.

The reading, transformation and storing of the complete set of Healthwise content (around 14000 files) takes less than 30 minutes.

Vicert was able to leverage its extensive experience in ATG and Java to complete this project in less than eight weeks.

CHALLENGE

Our client has identified a large business need within the Mid/Large Product & Marketing teams for a centralized repository to track portfolio benefit/blueprint changes over time and automate input of this information into matrices, blueprints and cycle benefits collateral.

This information was not stored in one place, and could only be found through reviewing email threads and multiple versions of Excel and MS Word documents.

OUR SOLUTION

Vicert produced a clearly defined architecture, including the database design, and development plan for the solution.

Main features of the solution:

• Identifying and reporting on current benefits.
• Identifying, tracking, and reporting out on changes to benefits, footnotes, and other blueprint items.
• Creating outputs comparing benefits across multiple plans and across multiple benefits within one plan.
• Facilitating entering changes across multiple plans and creating new plans.
• Integration with Microsoft Word and Excel to automatically produce various product and marketing outputs.

BENEFITS TO THE CLIENT

• Increased efficiencies by the reduction of manual processes and the reduced need for stakeholder review of the benefits and footnotes entered into the cycle collateral.
• Eliminating the error prone process of maintaining email chains and various Excel and MS Word documents. Those were manually updated, one at the time, making it a very time consuming activity with great potential for user errors and omissions.
• Improved accuracy of the output data. The accuracy of the Matrices and Blueprint output are critical since benefit changes information they document are communicated out to regulators, producers, employers and members and at the same time define the rules for payment of claims.

CHALLENGE

The primary challenge our clinet wanted to address was fragmented, extensively manual, departmental process used to move employer groups from sales prospect to installed status.

The nature of this process significantly influenced the level of administrative effort, cycle time and quality and had a negative impact on broker retention, staff moral and overall customer satisfaction at broker and employer groups.

Consequently, the top and bottom line were impacted by higher production costs, increased customer service costs, missed sales and renewal opportunities.

OUR SOLUTION

Vicert produced a web-based tool that brought the following:

• A single data source is created - all participants in the process have identical data entered only once.
• Several users are able to work on the same RFA request at the same time.
• Instead of moving the RFA Excel document back and forth, with possibility that multiple, inconsistent versions are created, all of the users involved have the access to the GIRT. Each of the groups/departments is able to locate the appropriate request and do its part in the process - enter, change or review data, generate the type(s) of report they need and download the documents they need.
• The time for each task is shortened, accuracy and consistency increased while the data integrity is preserved.

BENEFITS TO THE CLIENT

Administrative and production costs are lowered by:

• Eliminating redundant data entry at renewal,
• Eliminating extraneous and confusing data,
• Reducing re-work due to errors,
• Eliminating revalidation of RFA data at multiple steps of the process,
• Eliminating manual hand-offs between functional groups.

The tool has also improved output quality, increased broker and member retention and membership growth, and improved customer satisfaction by:

• Significantly reducing group sales and renewals cycle times,
• Improving broker perception of BSC enrollment capabilities,
• Driving performance levels to exceed competitive benchmarks,
• Implementing performance measurement and tracking,
• Establishing quality checkpoints along the process.

CHALLENGE

To be price competitive, our client is focused on reducing its Cost of Health Care trend. Letters of Agreement (LOA) are requests for claim discounts submitted by our client on behalf of their subscribers who receive eligible services at out-of-network providers.

It was discovered that LOA tracking was not being performed well. There were two tracking mechanisms owned and controlled by different groups. Visibility into LOA requests was minimal, and the status of the request was not available to all of the internal groups that needed to be able to see it. Operational reporting was difficult and there was no automated reporting.

OUR SOLUTION

Vicert produced a single web-based tool with the capability to address the shortcomings of the old tracking and monitoring tools. This includes the ability to:

• Provide secure access to users across the organization needing to provide and review information about the various types of LOAs,
• Track the status of the LOA as it moves from the initial request through negotiations to claim payment,
• Store and grant different levels of access rights,
• Generate operational and management reports,
• Track the appropriate level of system events/transactions and provide audit reports,
• Receive data uploads from and create data extracts to other client's systems.

BENEFITS TO THE CLIENT

In July 2006 and unrelated to this project, the client ran an internal audit of the process for all types of LOAs from all sources. Three of their conclusions were that "the LOA process is unsatisfactory," "controls surrounding the payment for claims for LOA do not appear to be working as intended," and there was a "lack of (an) audit trail."

With this new tool, our client has gained a solution that measurably improved and upgraded facility LOA tracking and reporting. One of the major benefits was improving operational workflows enabling the client's teams to maximize the number of claims being processed with LOAs.

Administrative and production costs are lowered by:

• Eliminating redundant data entry,
• Eliminating extraneous and confusing data,
• Eliminating use of disparate tracking mechanisms,
• Eliminating manual hand-offs between functional groups.

CHALLENGE

Our client has identified a need to modify and improve their IVR system by implementing new VXML application that should provide a wide range of online services for members, producers and providers.

This new VXML application should essentially provide the same information available on client's web sites but in a limited form (due to the IVR limitations).

OUR SOLUTION

Vicert’s responsibilities within the VRU project can be grouped into following two top-level tasks:

• BSI-API Design
• BSI-API Implementation

BSI-API is serving as the contract between the IVR application and the backend. Its interfaces are exposed via Plain Old Java Objects (POJO).

Main features that BSI-API provides are:

• WPR Data Retrieval
• Right Fax Integration
• Sigaba Integration
• MTM Data Collection

The APIs implement the business logic required for various transactions that the system should provide, such as data access.

BENEFITS TO THE CLIENT

The application is providing user experience that creates a new level of excellence in the healthcare industry.

Our client improved their service with more ports to handle traffic and enhanced reliability and performance.

The solution provided improved consistency for different groups (providers, members, etc.) and through different channels (IVR and Web).

The caller interactions got better by:

• adding some new functionalities
• adding speech for a more natural interface
• improving the structure
• improving the quality of the recordings

CHALLENGE

Within Electronic Data Interchange program, our client identified the need for an Internet based application enabling easy-to-use and readily available EDI 837 transaction capability. The solution had to be fully compliant with HIPAA standards for electronic transactions.

OUR SOLUTION

Vicert effectively mastered the complexity and size of the 837 transaction including 1200 pages of specs.

In the first project phase Vicert developed detailed feature specification and complete database design.

EDI/HIPAA application is implemented as a standard enterprise application.

BENEFITS TO THE CLIENT

Although this solution was never deployed in production, our client obtained a HIPAA compliant application facilitating paperless exchange of information with its business partners.

Extremely short time to implement (60 days).

CHALLENGE

Our client decided to improve the pharmacy section of their online member portal by replacing existing formulary data with the First Data Bank (FDB) drug database, adding the ability to search an exhaustive drug database and check drug interactions.

The company wanted a customized internet solution, which required customization of the FDB drug database, matching old formulary data with FDB drug data and building necessary links between the drug database and available insurance plans in order to show accurate coverage information to the members.

OUR SOLUTION

Vicert provided a clearly defined architecture and development plan for the solution:

• Consumer and member views of formulary and copay info.
• Shell scripts for automating FDB database import/update process.
• Administrative portal for complete drug database administration.

BENEFITS TO THE CLIENT

The client gained an effective drug database solution fully customized for its own needs, allowing precise drug information and copay values to be served to the portal members.

Administrative functionality built so that a clinical pharmacist can easily maintain the formulary data.

CHALLENGE

Deutsche Bank is one of the leading international financial service institutions. With more than 98,000 employees, the bank serves more than 12 million customers in more than 70 countries worldwide.

Building on decades of traditional leadership in the corporate banking market, Deutsche Bank needed a technology strategy that would create a web interface allowing corporate clients to access a number of the bank's products and services through both private and public networks.

In addition, Deutsche Bank wanted the application to be accessible by means of WAP-enabled cellular phones in the European market

OUR SOLUTION

Vicert immediately deployed a team to tackle the project, assess the technology needs and determine the path to the solution with minimal risk to the client. Vicert defined the best ways of integrating disparate information sources into a coherent and personalized banking portal interface. To comply with the diverse needs of the corporate audience the system's design allowed for seamless integration of a modern 3-tier enterprise computing architecture, streaming media and legacy systems.

Applying personalization, scenarios, streaming media and other advanced web technologies in a secure environment, Vicert created an application that allows users to navigate customizable financial products while viewing targeted content and delivering value added services. Of course, the ability to perform financial transactions was available according to the user access levels set by the system administrators.

BENEFITS TO THE CLIENT

By conducting our studies on as many open source technologies as possible, we were able to control cost while creating a robust solution to meet Deutsche Bank's needs. The first prototype was up and running within thirty days of Vicert's engagement on the project. All of Vicert's key strengths were demonstrated: we delivered on time and on budget, while leveraging our distributed development environment and our financial services experts from office locations on two continents.

CHALLENGE

Avaya Technologies, the telecommunications infrastructure manufacturer, wanted to leverage the power of the Internet to manage its large global network of distributors, partners and value-added resellers. This CRM system needed to provide personalized information quickly and easily to a wide range of customer types who had varying levels of access and information requirements.

OUR SOLUTION

Global Sales Accelerator solution allowed for the simple and efficient management of both user information and workflow on one end and document generation and management on the other. From user approval and access control configuration and reporting to content personalization and user type targeted e-mail, Avaya's team members can manage and control all aspects of the user experience via a simple web interface. The functionality of this web application expanded through four phases of this project, as the number of users and requirements to address specific business needs grew.

Visitors to the site were provided with immediate access to the precise information relevant to their needs, pulling appropriate documents, sales resources and other relevant information based on the user type, region and certification levels from a vast information set, as needed.

BENEFITS TO THE CLIENT

This extranet became a significant part of the Avaya Technologies Business Partner websites and the company's ability to manage a complex global network of VARs and resellers. To help Avaya manage functional and technical requirements, the solution was built robust and scalable from the ground up, while keeping budget and time constraints in mind.

We decided early on to only invest in more expensive application server platforms when the system truly required those platforms. This was the key to helping our client manage ROI and build the necessary trust to support this project over a 4-year period.

"The Vicert team helped us manage all of our requirements efficiently over the years. The application we wanted had to scale with our business as we learned about the needs of our customers and have developed processes to conduct our business more efficiently. This CRM project was extremely successful thanks to Vicert's process and experience." Jana Branisa, Webmaster, Lucent INS

CHALLENGE

Kaiser's primary business objective was to offer its customers the option of using a wider range of automated services to complete their inquiries, provided by the Interactive Voice Response system (IVR). To achieve this objective, Kaiser Permanente chose the Genesys GVP and Enterprise Routing Solutions.

Also, to collect and present relevant customer reporting data across nationwide call centers, Kaiser decided to implement a Custom Reporting solution, based on Crystal Enterprise Server and Genesys Call Concentrator.

OUR SOLUTION

Kaiser Permanente adopted their Comprehensive Delivery Process (CDP) as the standard and made it mandatory throughout the project phases. Following CDP reaped many rewards during the project, but at the same time required the engagement of highly skilled consultants familiar with the methodology.

It was Genesys' challenge to engage such resources, and they opted to look for an adequate partner company that could support them with CDP-like expertise and the ability to engage skilled consultants across multiple sites at the same time.

Genesys' decision was Vicert. Vicert was engaged for Infrastructure-Architecture analysis, GVP installation and configuration, Routing Strategies design, and Custom Reporting Solution development. During the engagement, Vicert delivered Infrastructure-Architecture CDP documentation, as well as comprehensive project documentation, covering all project phases including GVP installation and configuration, Custom Reporting Solution and Routing Strategies.

BENEFITS TO THE CLIENT

With help from Vicert, Kaiser achieved its primary business objective, and offered its customers a wider range of automated services. Completing more transactions within the IVR system reduces the number of agents and supporting staff required to otherwise handle those calls, significantly reducing costs.

For the pilot rollout, initial targeted percentages of callers that were able to successfully complete their transaction within the IVR were met, and even exceeded, improving Kaiser's initial ROI.