Symfact Supports Provider Management

Posted on
Author Symfact
Categories Case Studies


Customer

Medica is a health services company headquartered in Minneapolis and active in the Upper Midwest. The non-profit company provides health care coverage in the employer, individual, Medicaid and Medicare markets. It operates in Minnesota, Iowa, Kansas, Nebraska, North Dakota, South Dakota and Wisconsin. Medica also offers national network coverage to employers who have employees outside the Medica regional network.

Medica’s vision is to be trusted in the community for our unwavering commitment to high quality, affordable health care.

Business Challenge

Medica managed provider contracts and contract changes using multiple complexes, Access databases, and spreadsheets. Information about these provider agreements (changes as well as new agreements) was gathered from several sources and entered in these databases and worksheets. Moreover, several departments often needed to review and approve the submitted Provider data before a new or modified agreement could be drafted. With the anticipated geographic expansion and discrete data sources, Medica sought a more economical and efficient way to scale its process and systems.

Solution

The deployed solution provides a central, integrated system that supports multiple Provider transactions using an integrated workflow for managing the activities of several departmental swim lanes. Any new Provider activity can now be managed across the company using a single integrated system. Within any provider review, department assignments can be assigned based on workloads, managed from a secure place for all stakeholders. Each Provider transaction workflow can be defined by Medica with regards to inclusion, sequence, and precedence of any required department. The Symfact system will also generate the resulting Provider agreement and manage the execution of the agreement through e-Signature.

Solution Highlights

Working with Symfact the customer has improved its efficiency and contract visibility of the management of large complex agreements:

  • Separate Departmental workflows of any Provider transactions defined by Medica
  • Task assignments based on staff workloads
  • Single repository for Provider agreements eliminating re-entry of data
  • Automatic generation of Provider agreements based on transaction type with e-Signature integration for contract execution
  • Elimination of duplicate data entry and the sun-setting of five internal systems and
  • Foundation to expand the solution to incorporate all Provider data management and demographics support for Directories

 


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