Notes From the Field: Pet Insurance Claim Automation Solution

Capture, Workflow, ECM and ERP: Recipe for Automation

I had a great call with one of our customers the other day, a major pet insurance organization.   Keeping on my theme from my previous post (Capture+BPM: Pre, Midstream, Post), I wanted to share some details.  They have built an amazing solution to automate their inbound claims process.  Here is the lay of the land, pre-solution:

  • They provide pet insurance for their clients
  • Clients file claims that include invoices from vets, etc
  • They receive 6,000-8,000 claims per week.
  • Before the solution, everything was manual, received by fax, email and inbound paper mail
  • Data was being entered manually into their ERP
  • Documents were being saved manually, one-by-one into their ECM system
  • They have stringent regulatory SLAs for claim turnaround and response
  • New regulations required detail down to the line items on invoices filed for claims
  • It was taking 60-70 business days once a claim was received to process

Ah, the pain of manual processing.  Here is the teaser, after implementing the solution, they are now down to a 20 day turn around, and believe through further tuning they can get to 7.  So, they have taken the time to process down to a third or their pre-solution burden, and create an overall electronic system for claims processing.

Claims Workflow Queue
Processors Now Have a Digital Queue

The solution has made the process remarkably efficient, taking us from 70 days down to 20 to process a claim.

The Solution Architect

So, here are the components of the solution:

Ephesoft (Capture)Ephesoft’s intelligent document capture solution is used to capture and classify claims from inbound fax, email and paper files.  Through its advanced learning engine, it auto-identifies the type of document, splits multi-invoice PDFs, and then extracts the invoice information down to the line item data.  The documents and XML are then passed to the workflow engine.

extract claim data
Ephesoft Classifies and Extracts Inbound Invoice Data

There is quite a bit more that happens within the front-end capture.   This organization has enabled review and validation where they can actually review questionable documents before they get passed to the workflow.  This prevents bad data and documents from entering, and allows a checkpoint for insuring a complete claim package.  Rejected claims are passed back to the customer, with a note about what is required to complete the claim.

insurance claims validation
Ephesoft Automated Validation and Rejection of Claims

Finally, they have also implemented capture through Ephesoft web services.  Through a web portal, the customer can upload claim documents, and they are passed via web service to the capture engine to be classified and have data extracted.

document capture and OCR web services
Web Page Front-end For Ephesoft Web Services

You can learn more about web services for OCR and document capture here:  Web Services for OCR, Capture, Classification and Data Extraction

BPLogix (Workflow) – The Ephesoft data package is ingested into the BPLogix workflow engine, and then presented to claims processors for review and extensive validation.  With the new regulatory requirement on-line item invoice detail, this is a critical step.

workflow for claims
The Workflow Engine Receives the Extracted Data

Microsoft Dynamics AX (ERP)– once all the data is verified and validated, all the claim data is placed into the ERP for final processing and payment.

capture to dynamics
Ephesoft Data in AX

Alfresco (ECM) – Once all is complete, the claim documents are placed into their end resting place, and can be accessed at a later date if an issue arises, or there is a need for further review.

alfresco
Alfresco is The End Resting Place 

Great use of multiple technologies to automate a painful business problem.  Shows off the true value of document capture within workflow to add another dimension of process efficiency.  What do you think?  Any success stories to share?  Please comment.

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Notes From The Field: Beyond SharePoint Workflow

Beyond SharePoint Workflow

What Companies Look For As A Next Step In Their BPM Journey

As I continue to work with customers and prospects, I find some common ground in those looking to expand beyond SharePoint Workflow and Forms (And those products that rely on the underlying engine) .   There is definitely a BPM journey that organizations seem to take, regardless of whether they realize they have embarked.  This journey almost always leads to expanding beyond the confines of SharePoint, as well as a deepening need for more complex capabilities.    Here are some of the common trends I see in organizations looking to take their business process management to the next step:

  • The Requirement for Complex Workflow Patterns (With No Code) – simple serial workflows can only take you so far, and organizations quickly realize that rework steps, and moving to previous steps in any process is an absolute necessity in common business flow.  Having a BPM platform that integrates with SharePoint lists and libraries, and provides support for all types of workflow patterns can provide immense value, and eliminate the need for complex custom code and management of state.
Complex Workflow in SharePoint
Rework Should Not = Custom Code
  • Wanting Reusable, Shared Data Layer and Simple LOB Data Access – Accessing external data in SharePoint can be challenging, and I find many companies are looking to simplify the integration with external business systems.  The tiresome process of setting up Business Connectivity Services/External Lists in SharePoint, and maintaining them can be problematic.   A reusable model, as seen in K2’s smartobjects, can provide agility and reduce the overall time required to configure forms, workflow and reports.  The “create once” and reuse theme provides power and flexibility.
SharePoint External System Integration with Data
Simple, Visual Data Integration Tools
  • The Need to Surface Forms and Workflows Outside of SharePoint – SharePoint is a great tool, but should every form and workflow live  within its UI?  More and more, I am seeing organizations that want to have business apps (forms, workflow, data and reports) that live outside of SharePoint and can stand alone.  This is especially true when it comes to mobility, and the need to support various device types with web-based forms.
Supporting SharePoint access through mobile devices
Support for Mobile
  • The Need for A Broad Set of Design Tools – BPM in any organization is a broad undertaking, and usually involves a wide variety of individuals, with varying skill sets.  With Business Process Design, one size does not fit all, and organizations are looking to support power users, business analysts and developers.  See my post: BPA, BPM and Design.

So, in summary, if you are looking to step outside of the SharePoint workflow engine and its forms capabilities, take some time to evaluate your next step in the journey and focus on at least these 4 points.   For some additional considerations, see the below post:

10 Key Features In 3rd Party SharePoint Solutions

Comments?  Thoughts?

Process Automation Gauge: How Many Processes?

How much process automation

Poll Of 500 Executives: How Much of Your Workflow is Automated?

Process Automation for Business
Just how automated are your processes?

This Cognizant poll was very interesting, and see the below stats:

  • Execs believe 25-40% of their processes are automated
  • 50%+ believe that business process automation will have a significant impact on business operations within the next 3-5 years.
  • 1/5 reported greater than 15% cost savings through process automation.
  • Banking and Healthcare led the way in cost savings through automation.

To see the full article, click here:  Intelligent Process Automation – The Study

More info on process automation: BPM and BPA Software

 

 

SharePoint 2010 End of Life

SharePoint 2010 Workflow end of life

Where will all the workflow go?

We have passed the end of life of SharePoint 2010, and it will no longer be supported through standard support as of 10/13/2015.  This will force the hand of customers that have been lagging behind in migration to SharePoint 2013/SharePoint Online, and it will be quite interesting to see how customers will transition.   Many of the prospects and customers I see in the field are slowly moving their content in phased projects from 2010 to 2013.

If you haven’s evaluated your forms and workflow options, it is a great time to examine your future platform for both forms (Move away from InfoPath), and workflow.  K2 is a great option for an overall BPM/BPA platform, and can help bridge the gap during migration, as we support SharePoint 2010, 2013/Online.

End of life announcement below:

SharePoint 2010 End of Life 10-13-2015

For more information on an InfoPath replacement, see: InfoPath Replacement in K2

To see how you can transition your SharePoint 2010 Workflow to K2, see:  SharePoint 2010/2013 Workflow with K2

 

What is Workflow Software?

Just what is workflow?

Workflow: Just What Does It Mean?

Ah, workflow.  Walk into any office today, and ask for a definition, and you will get a myriad of responses.  Blank stares.  Long dissertations.  It gets even fuzzier when you cross between business and technical folks.  So to get a level set, here is Wikipedia’s definition of workflow:

Workflow defined
The Definition of Workflow

Wow, that’s a mouthful.  So, to make it even more complex in the software world, there is a sea of acronyms and terms (see past post BPM Alphabet Soup ) surrounding applications that encompass workflow, as well as other technical functions.

So let’s get simple.  Workflow, in the physical world, is just the way we get work done.  The means to an end, or the path to a successful business activity outcome.  In the past, that would have been:

  1. Bob fills out the paper order form.
  2. He drops it in the sales order inbox at HQ.
  3. The order is manually routed to Joe, the sales manager for review.
  4. Joe give it to John the mail clerk to take down to fulfillment.
  5. And on and on.

But the most important part today, in our technical world, is the interface between people and technology to facilitate new and efficient business processes.  So with that said, in the modern workflow application, there are typically 4 pillars:

  1. Digital Forms – the paper form has now been replaced by a smartform, or intelligent user interface (UI).  The UI is now dynamic, and is used in many cases to kick off the whole workflow process.
  2. Process or Workflow Engine – the engine facilitates the movement of tasks and information throughout the organization.  It is the “digital mail clerk” and much more.  Notifying, delivering and controlling the entire work process from start to finish.
  3. Data – the modern organization now houses its information in digital systems, most focused on specific areas.  This is the foundation layer on which all workflow occurs, and stores the information required to facilitate a successful process (An example of this data layer is K2’s patented smartobject for workflow and digital forms).
  4. Reports – As work is being completed, information about the process is made available in the form of reports.  It is this insight that provides the ability to incrementally improve process or the flow of work.

Thoughts?  Additions?  Comments?

 

 

BYOA in Healthcare: Quick Sample of a Rapidly Built Advice Nurse App

Healthcare process automation

Workflow and Forms in Healthcare, Hospitals and Medical Clinics

Building Your Own Apps

I wanted to share a quick proof of concept I built for a healthcare organization that was struggling with automating their process in their telephone nurse advice center.  This video shows using K2 Workflow, Forms and Data to build out a quick app for managing calls, and the new tele-patient process.   This process was built using K2 blackpearl, the no-code Business Process Applications (BPA) platform.

Here is a great link for more info on BYOA in Healthcare and Medical: Business Process Apps in Healthcare

Amazing Statistic on Data Volume Explosion

Can we control the data explosion with workflow?

Explosion of Data in Company Workflow
Slide from K2 Slide Deck on Controlling Data with Workflow

 

What’s Missing From SharePoint? Infographic

Augmenting SharePoint Workflow and Forms

 

To see the full infographic, click on the image below:

SharePoint Workflow
Click the Image for the Full Story

What’s in Your SharePoint Workflow Box?

SharePoint Workflow

Key Features for SharePoint Workflow Enhancement

SharePoint Workflow Key Features
Click to See K2 Appit

Top 4 Reasons To Make The Move From IBM Lotus Notes

Notes replacement and migration

Migrating Away From Lotus Notes

More and more organizations are choosing to migrate from Lotus Notes and Domino, and move to a more robust, flexible platform.  Below are the 4 top reasons to move away from Lotus Notes and optimize your business applications:

  1. Efficiently build and rebuild your applications – the development cycle in Notes is notoriously long, and plagued with hard to find resources.  Gravitating towards a no-code application platform can alleviate the timing issue, and put power in the hands of non-developers.
  2. Leverage existing investments – crossing silos in IT infrastructure is required for efficient business process, and leveraging infrastructure and investment in enterprise line of business apps is a necessity.  Access to Microsoft systems, as well as SAP, Salesforce and other systems of record is a must.
  3. Manage applications from start to finish – the ability to provide insight to application and process has become a standard for efficiency and maximum productivity.  Reports and data need to be easily accessible and readily shared.
  4. Agility and Change – building the monolithic app that takes years to assemble and months to modify can no longer be an operating mode.  Business must quickly adapt to markets and customers, and take advantage of all the benefits of rapid change.

Additional articles here:

Migrating Off Lotus Notes

Just How Much Does an App Cost?

Want to learn more?  See the online guide to Lotus Notes replacement here:

Lotus Notes Migration and Replacement Whitepaper