Case Study Healthcare OrthoNet

MaxxVault Success Story | Healthcare

Managing Managed Care

OrthoNet-LogoOrthoNet is the leading orthopedic specialty benefit management company in the United States. Headquartered in White Plains, NY with offices in California and Florida, OrthoNet’s mission is to advance the delivery of musculoskeletal health care. Ensuring they can find crucial information rapidly and process claims quickly is a key component to their success.

OrthoNet’s customers include health maintenance organizations, medical groups, IPAs, indemnity insurers, preferred provider organizations, managed care organizations, workers’ compensation insurers, and other payors. In order to help doctors deliver the best care possible and spend more time with patients, OrthoNet realized their existing file processing and document delivery system required a shot in the arm. OrthoNet needed a system that could automate the sorting and delivery of documents to enhance customer service and improve the bottom line. Because it met these key requirements, MaxxVault Enterprise was chosen as the solution to automate OrthoNet’s claims processing operations.

Over 1000 new documents per day must be identified, filed and routed

Every day, insurance claims arrive via fax from any of the 80,000 orthopedic health care providers OrthoNet supports. MaxxVault processes the documents for patient and health care provider identification numbers, matching them against the database. If the patient and provider are already in the OrthoNet system, the rest of the index information is auto-filled. If they do not match, the documents are routed to the Contract Assistant who verifies that the information was captured accurately and either makes corrections or enters the new patient information into the OrthoNet business system.

Once indexed, MaxxVault associates documents to open case files or a new file is opened if one does not exist. The processing workflow is then triggered and the responsible Contract Manager is notified that a new document has arrived ready for action. Contract Managers, doctors and other users included in the workflow have the options to complete their step, send the document back, re-assign it to another user (or user group) and forward the document to someone outside the workflow for clarification. At any time throughout the workflow process the documents are accessible to the customer service agents who need to answer inquiries from the patients and providers. Once the claim has been processed and the case closed, the documents move to the archive where they are locked as read-only records.

MaxxVault Enterprise has helped OrthoNet exceed their goals

Documents are now sorted, indexed and processed faster while also being more accessible than ever before. Paper copies are almost completely eliminated, saving time and improving efficiency. Supporting documents added to an open case can quickly be linked to the primary document with a simple click. Because of these improvements, Contract Managers work more quickly, process more claims, and are able to keep tabs on documents they have sent to doctors for review. Additionally, MaxxVault Enterprise provides peace of mind for their IT support team. Because the administration of MaxxVault is so simple and intuitive, the OrthoNet IT team does not have to rely on specialists to make adjustments to the system.

With MaxxVault Enterprise in place, OrthoNet’s communication with their network of health care customers has become faster, more efficient, more accurate and less expensive. And as OrthoNet grows, MaxxVault system utilization can seamlessly scale to address expanded applications and subsequent increase in workflow.

At OrthoNet, simple just got easier.

Benefits realized:

• Paperless claims processing
• 1,500 new documents per day
• Forms processing automatically identifies documents
• Automatic verification of document IDs
• Documents are automatically routed within minutes
• Document assigned to clerks based on existing cases
• Assign documents in workflows to a user or group
• Supporting documents instantly linked to key files
• Documents in workflows remain available to customer     service
• Claim file sent to read-only archive upon completion

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