Health and Dental Claims Processing

 

Customer Overview

The Military Medical Support Office (MMSO) provides medical and dental claims processing and customer service for eligible United States Department of Defense Active Duty Military and Reserve Service Members.

Needs

MMSO needed to improve the performance and functionality of its CPSII Claims Processing (CPSII) system and IBM FileNet document imaging system.

Solution

QFlow implemented numerous enhancements. The CPSII application and Oracle database were tuned. The document entry process was upgraded with new scanners and imaging system software. A new distributed scanning and indexing application was developed and implemented. Fax servers were integrated so incoming faxes are routed to the indexing application. Incoming scanned and faxed claims forms are better integrated into the claims processing workflow.

Benefits

The performance of the CPSII system is greatly improved. The process flow is streamlined and claims are processed faster. Claims forms are stored electronically which has reduced the amount of office space needed to store paper files. Since Customer Service representatives can view members™ claims files on-line, questions can be answered during the initial call.

Services Provided

QFlow consultants analyzed the existing CPSII system and recommended changes to improve performance and functionality. QFlow developed and implemented the recommendations. QFlow continues to provide application enhancements, remote system management and system maintenance services.

Technical

− IBM FileNet Content Services;
− Kofax Ascent Capture;
− Oracle database; and
− Borland Delphi.