Case Study
From Tedious to Terrific: Confronting the Challenge .
Sales order creation and maintenance in Life Science organizations varies from a simple, to a very complex process where patient, patient’s relatives, different providers, and several health insurance organizations are involved in the sales order life cycle.
Coforge have developed an innovative solution to address these challenges, leveraging the power of the Appian platform. The platform is scalable and can be extended to external business systems to accommodate all parties involved and expanded to different process variants to support dynamic case management.
Business Problems:
- Lack of end-to-end visibility into the sales order management process were patients, providers, and insurance organizations get involved and influence the process outcome.
- Adhering to payer guidelines and compliance issues which vary from payer to payer and the health condition of the patient.
- Detection of disqualified orders based on specific payer rules
- Tracking and follow-up of must-have information and documentation to support each case
- Confirmation of future payments and tracking the authorization period which varies by case
- Missing out sales revenue for disqualified cases which can be resolved via appeal or clinical review
- Faster delivery of the product to the patient in need track claim status, policy status, etc.
Solution Highlights:
- Built on Low Code platform - extensible, expandable or shrinkable based on business needs and organizational process fit.
- Unified platform to connect all related stakeholders for a seamless process outcome
- End-to-end visibility and tracking of sales orders
- Adherence to compliance and specific payer rules
- Minimizing revenue lost by auth-based payment assurance
- Faster closure of sales orders by automatic follow-up for documents and information from different stakeholders
- Operational excellence by early detection of disqualified cases
- Improved TAT for contact centre employees
High-Level Process Map:
The sales order process for medical equipment varies depending on whether the order is a rental or bought order for a homecare patient or for a facility. Creating a sales order for a homecare patient requires capturing and maintaining various types of information on a patient’s illness, payer's details, providers, and clinical documentation which are needed to qualify the order and ensure faster delivery of products and uninterrupted payment from payers. For a homecare rental order, this information is leveraged further for order maintenance, servicing, and ensuring rental revenues for each cycle.
End-to-End View of the Sales Order Process:
The sales order process for medical equipment varies depending on whether the order is a rental or bought order for a homecare patient or for a facility. Creating a sales order for a homecare patient requires capturing and maintaining various types of information on a patient’s illness, payer's details, providers, and clinical documentation which are needed to qualify the order and ensure faster delivery of products and uninterrupted payment from payers. For a homecare rental order, this information is leveraged further for order maintenance, servicing, and ensuring rental revenues for each cycle.
The sales order management process caters to any type of order – rental, facility, charity or private pay orders. The solution keeps relevant parties associated with the order involved informed, ensuring seamless product delivery and payment. The solution is compliant with regulations and payer requirements, ensuring a much faster release of orders.
Benefits:
- Streamlined sales order creation process
- Improved operational efficiency for contact center and order processing teams through automatic tracking of data and document requirements
- Efficient and compliant data capture through automatic data validations
- Faster turnaround times for releasing orders
- Maintain adherence to regulatory compliance such as HIPPA and specific payer rules
- Early detection of disqualified orders and managing those through to resolution
- Revenue assurance for every order by securing authorizations and approvals from payers
- Flexible solution to accommodate multiple parties as needed
- 360 view of the sales order process for faster and more informed decision making
- Real-time tracking and monitoring of each sales order
Leveraging the Power of Appian:
- Low Code solution template can be extended to external parties, expanded to any process variations, or reduced to a smaller process flow as per the business need.
- The application manages multiple parties involved in the sales order process.
- A holistic view of sales order data in one UI for better-informed decision-making.
- Ready-made extension points for external integrations
- Built-in support for any process variations
- A configurable solution to accommodate different types of sales orders
- Manage specific payer guidelines to ensure faster payments
- Ensuring compliance with HIPPA
- Intelligent follow-up for pending documents to speed up the order process
