"Datawatch|BDS provides the CSR immediate access to an exact copy of the customer's EOB. They see the same docuemnt that the consumer sees and no longer have to search for relevant data or guess at what it means."

 

For health insurance companies, the EOB (Explanation of Benefits) is one of the primary ways to communicate with clients. Empire Healthchoice (New York), one of the largest Blue Cross/Blue Shield associations, wanted to make it easier for clients to get accurate answers to questions about their EOBs.

One way was to make those documents accessible online. Another was to make the process of discussing those forms easier for the users and for the CSRs (customer service representatives) who answer questions about them. An obstacle to this second goal was the fact that the printed version of the EOB didn't always look like the one the CSR would see on the computer screen. An integrated archival retrieval solution from Datawatch Corporation has made the resolution of customer concerns much easier.

COMBINE USER CONVENIENCE WITH LEGAL COMPLIANCE

The Datawatch solution is supported and operated by Xerox Corporation on behalf of Empire Healthchoice. With assistance from Datawatch Professional Services, Xerox implemented Datawatch|BDS (Business Document Server) to capture, index, and store the composed data streams of the EOB. The data is stored in native format, which can be reprinted and still maintain all the strict compliance required by the insurance industry. When a document is requested for online view, Datawatch|BDS transforms the data stream dynamically into a PDF (portable document format), one of several supported data types. The browser-based PDF display has the advantage of enabling thin client access. The same document can be retrieved by end customers, doctors, or the supporting health organization via the Internet and by CSRs via a company Intranet.

Empire had made significant network infrastructure investments as part of this initiative. Datawatch|BDS runs on two Sun Solaris e4500 servers and two Sun Solaris a3500 servers. Actual presentment to end-customers is through IBM Global Services. IBM WebSphere handles all encryption and authentication, passing queries on Datawatch's HSM (hierarchical storage management) and routing index "hits" with links to the archive.

FROM PROPOSAL TO IMPLEMENTATION

Empire's main objective was to improve CRM (customer relationship management). Prior to this solution, CSRs were seeing production, transaction, and variable data associated with fulfillment, and waded through extraneous information. Datawatch|BDS provides the CSR immediate access to an exact copy of the customer's EOB. They see the same document that the consumer sees and no longer have to search for relevant data or guess at what it means. CSRs can work through a problem with customers in real time, can provide an instant reprint, or can direct the customer to access their document from Empire's website - all providing dramatic improvements in customer service. While specific metrics are still in development, the solution has been a success in reducing call time and increasing the number of inquiries that are completed in the first call. Datawatch|BDS provides the additional benefit of reducing the learning curve and training time required for new employees.

In addition to insurance applications, Datawatch|BDS has been very successful in banking, financial services, healthcare, government, manufacturing, and other industry environments.

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