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A Pivot to Paperless Reduces Costs and Complexities

A Case Study
This DataOceans client wanted to reduce the costs and complexity of paper documents, simplify the payment process and enable self-service for members and group administrators.
Increase in digital group invoices
Increase in electronic communications & payments
Reduction in service calls
Reduction in billing & call times

For over 40 years this Health Insurance client has aimed to help its members live healthier lives, delivering not only plans but excellent services. This carrier provides group and individual plans as well as Medicare Advantage to the market. Its high quality, cost-effective health plans and commitment to its members has made it one of the oldest and largest not-for-profit health plans in the southeast.

The Challenge

Group and individual invoices and other health insurance communications can create confusion, customer frustration, increased service calls and delays in payment. Additionally, managing communications and payments to providers can be costly and inefficient, particularly when they are exchanged through the mail. This DataOceans client wanted to reduce the costs and complexity of paper documents by enabling eDelivery of group invoices and Explanations to the Provider (“EOP”). They wanted to simplify the payment process for groups by allowing communication recipients to interact with the invoice and securely provide payment information. They also wanted to enable self-service for members and group administrators for functions like enrollment, account updates, payment management and premium adjustments.

This client also needed to reduce print and mail costs, delays in adjudicating claims and unnecessary complexity and cost resulting from mailing EOPs and provider payments. Complexity and delays in the process of working with providers not only increased cost but also impacted the patient and insured experience. Transitioning to a digital communication solution for interacting with providers and increasing EFT and EDI transactions was a must.

"DataOceans ability to integrate with our core systems and provide electronic communication and self-service is essential to our digital transformation strategy."


The DataOceans Solution

DataOceans’ ability to handle data from multiple sources and integrate with banks and other payment providers allowed for rapid transition to digital invoices and EOPs, and the immediate impact of increased electronic delivery and reduced service cost and complexity delivered a quick ROI.

DataOceans implemented eDelivery capabilities for EOPs and group invoices including enhanced PDF and self-service portal integration to reduce print and mail cost and servicing costs. The electronic EOP enrollment process was designed to enable providers to go paperless, eliminating the need and cost of mailing documents so voluminous they were mailed in boxes. It also established EFT with the respective providers. The combination of electronic communications, EDI and EFT resulted in reduced cost and complexity for the insurance carrier and provider. The resulting efficiencies reduced costs passed to patients and made for a better experience through more rapid claims resolution.

Electronic delivery of group invoices and improved self-service capabilities provided by the DataOceans platform resulted in improved customer experience for both members and group administrators. Updating of account information, management of enrollment and premium adjustments was accelerated as communication recipients could self-service instead of working through mail and phone interactions. Electronic capture of payment information and functionality to self-manage payment methods provided privacy and data security benefits. It also accelerated the time to payment of premium by eliminating inefficiencies associated with direct billing. This enabled the health insurer to pass on savings and make additional investment to improve the member experience.

The Future

The client is exploring expanding the number of payment methods available to members and is evaluating the continued expanded use of SMS and self-service functions to further reduce support and service costs and to continue to improve the member experience.

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