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Casestudy-Claim Management Services Inc., U.S.A..

Memorial Hermann Health Network Providers is a leading health care provider for the greater Houston and southeast Texas communities. A wholly owned subsidiary of Memorial Hermann Healthcare System, MHHNP serves employer groups ranging from 60 to 16,000 employees. A team of 120 employees provides health benefit administration services.

They offer employers a comprehensive, integrated managed care approach to health benefit administration under a self-funded direct employer contract arrangement. Aggressively priced physician and hospital contracts provide access to more than 3,000 physicians and 14 acute-care facilities in Houston, while providing nationwide coverage through partnerships with top ranked national networks.

Technology
ASP, MTS, IIS SQL server on Win NT/2000 platform.

Client's Feedback
Client continues to be extremely satisfied with Clavib services. The Client now utilizes Clavib exclusively for maintaining their application and the data. Clavib has been able to deliver superior service to the Client on a consistent basis and got applauds from the client.

Business Problem
MHHNP faced a challenge that many Third Party Administrator do: their aging claims system, modified with many workarounds, was still functionally sound, but it was difficult to customize and was based on technology that limited flexibility. The Group had long been in search of a “best of breed” claims management system, one that would offer tangible business benefits along with technological advancements. Clavib’s Solution for Claims Management was identified from one of their competitor and approached Clavib for implementing As-Is solution with minimum modifications.

The Clavib Solution
Clavib team of skilled professionals worked closely with several application owners to devise a user-friendly system that would provide Web-based application to installation and maintenance without the need for a lot of user interface or technical knowledge. Our team could bring out a secure, web-based interface to the end users. The application could handle the end user request in a Web-based environment and generated user specific information.

Value Perceived
The following is a partial list of the improvements that were achieved by MHHNP:

  • To deliver a valuable service to the client, which exposes shortcoming in their existing broker relationship.

  • As a tool to prevent clients from contacting their offices for advice, guidance and information.

  • As a shield against competing brokers challenging the client relationship at renewal time.

  • Enhancing the workflow.

  • Standardizing the claims process.

  • Helping to measure the process.

  • Optimizing automation.

  • Enhancing productivity.

  • Enhanced and expanded management reporting and decision support capabilities.
 
 
 
 
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