With business growing for a key service offering and a need for processes to scale, ClaimSecure chose TimeSeries and the Siemens low-code platform Mendix to transform manual workflows to digital.
Canadian healthcare claims management business ClaimSecure, processes more than 10 million health and dental benefit transactions a year, totaling more than $1.3 billion.
While North Americans with medical insurance often expect their plan to cover all medicine costs, this isn’t always the case. Certain drugs, sometimes costly and specialized ones, might not be covered, often leaving the individual to fund the cost themselves. ClaimSecure administers health benefit plans on behalf of organizations (plan sponsors) that provide them to their staff (plan members) as a benefit. As part of its mandate to support its clients and their plan members, ClaimSecure assists members in pursuing alternative funding, when drugs are not covered by the plan members health benefit plan. This rapidly growing aspect of ClaimSecure’s business recently underwent a digital transformation.
Coverage Navigation Service
Under ClaimSecure’s Coverage Navigation Service, plan members seeking help to pay for medicines are introduced to assistance schemes offered by provincial governments, social services, and pharmaceutical manufacturers. While these programs can be tricky and time-consuming to apply for on your own, ClaimSecure has the expertise to assist plan members secure coverage under these programs.
ClaimSecure’s internal work processes for managing the coverage navigation service used to be largely manual, with records kept in Excel or Microsoft Access. As ClaimSecure’s business in this area continued to expand, managing multiple case records between program coordinators was becoming increasingly challenging.
Additionally, ClaimSecure and its clients require regular reports to show KPIs are being met and cases are being resolved. Compiling the required data from multiple and disjointed information sources was getting unwieldy.
Senior management at ClaimSecure recognized the need for a digital case management application capable of offering the user a centralized, single view. But there wasn’t a suitable product available off-the-shelf. Consequently, ClaimSecure evaluated the possibility of having the app built in a low-code development environment. It brought in TimeSeries to conduct a thorough review of available options.
Using criteria defined in the TimeSeries low-code evaluation framework, ClaimSecure and TimeSeries agreed upon the Siemens low-code platform Mendix. ClaimSecure liked the idea of the speed and cost-effectiveness of developing in Mendix versus traditional coding, and valued the excellent reputation of TimeSeries as a Mendix development partner. ClaimSecure’s decision to work with TimeSeries was influenced by TimeSeries’ low-code development expertise, and timely product delivery schedule.
Director of Drug Strategies and Innovations
One of the many upsides of developing in Mendix is that it enables flexible, iterative development. TimeSeries demonstrated alternative functions, features and interfaces to the ClaimSecure team, and after seeking feedback, further refined the app to meet user needs and accommodate additional requirements.
“TimeSeries’ developers were skilled at articulating our design options and guiding us towards the right choices,” said Linda Lin, who was business lead for the project. “They spoke both the language of business and of IT, were happy to accommodate changes as our ideas evolved and were sensitive to our requirement for the app to keep patient data private and secure.”
As well as designing, developing, and implementing the Coverage Navigation Service claim management application for ClaimSecure, TimeSeries also partnered with ClaimSecure’s IT group to integrate the app with several of the firm’s internal systems, such as billing and reporting.
A great result – and speedy too
App development time from concept gathering to delivery was incredibly fast. With the claim management system now live, ClaimSecure is able to provide an enhanced, higher quality and more timely customer service.
ClaimSecure case management personnel have access to a holistic case history for every plan member that they manage. They can keep track of new and existing cases and any tasks associated with those cases. Within each case, the user has the ability to easily view/edit the member’s information, track pursued funding sources and the progress of each, send emails (based on templates and information of the case), set up to-do tasks, track calls specific to the case, and add applicable documentation.
Reporting is now simple too; a couple clicks to generate standard and even ad-hoc reports as required internally or by plan sponsors.
From a business perspective, the app is enabling manpower efficiencies and delivering improved customer satisfaction. The Coverage Navigation Service can also be quickly scaled to support new business, new plan sponsors and plan members.