Two scenarios: Electronic appeals with OnBase Mackinac, and without

Here are two medical documentation scenarios. Which one would you rather participate in?

The typical appeals scenario …

At the hospital

It’s Monday morning. Bob from the hospital’s Patient Financial Services team grabs a cup of coffee and looks at the long list of claims that need to be appealed. The report seems to go on forever, and it will take most of the day to make a dent.

Bob knows it is going to a be a day filled with printing, photocopying, uploading to portals, faxing and then hitting the phones. He sighs and takes a sip of coffee.

At the health plan

The Appeals Coordinator, Nadeen, grabs a Mountain Dew on the way to the office. She walks in to find that the mailroom has just brought in the early run from the post office. Monday is a killer day for appeals.

Three U.S. Post Office bins are filled and stacked on the center table in the Appeals area. The day will be filled with opening, reading, triaging, sorting, prepping, scanning and entering data.

And that’s just a part of it. Another co-worker is checking for electronic faxes delivered to the Appeals Outlook email box. Another is seeing what came in from the provider portal.

It’s going to be another rough Monday, but at least there will be some overtime pay involved. Nadeen grabs her Mountain Dew.

Sounds kind of bleak for a Monday morning, right? Well, in a very short time, these scenarios may seem simply old-fashioned.

The future appeals scenario (with OnBase Mackinac) …

At the hospital

It’s Monday morning. The Patient Financial Services team grabs their water bottles and opens OnBase. The week is off to an easy start, as OnBase Mackinac has pre-built the day’s appeals based on a feed from the Revenue Cycle Management (RCM) system and queued those appeals for review.

Bob reviews each item in the queue, confirming the data is correct and the documentation attached to the appeal is accurate and complete. When the review is complete, Bob clicks “Submit” and OnBase Mackinac delivers those appeals securely to the associated health plan.

At the health plan

Nadeen takes a sip of her chamomile tea – she gave up her bad Mountain Dew habit a month ago – and logs into the OnBase Appeals & Grievances solution. Her health plan uses OnBase A&G to triage, manage and complete processing of all appeals and grievances from providers.

In OnBase A&G, Nadeen sees a queue of items sent in electronically via OnBase Mackinac.

Appeals cases have been automatically created for electronic appeals, faxes and portal uploads. With all the opening, sorting, prepping and scanning now unnecessary, Nadeen focuses on making sure that all the appeals are complete so nurses and doctors downstream at the health plan have everything they need to quickly and efficiently review the appeal.

If Nadeen finds an appeal that is not complete, she simply clicks on the “Need more Information” button and adds a comment of what she needs from the hospital to process the appeal. When she clicks submit, OnBase Mackinac delivers the appeal electronically right back to Bob in Patient Financial Services to process.

Select the right scenario

The future is yours to choose. With OnBase Mackinac, you can create secure workflows between healthcare organizations for a variety of scenarios.

Or you can continue to print, photocopy, upload to portals, fax and then hit the phones while you chug coffee and Mountain Dew. It’s up to you.

* This blog post was originally published on LinkedIn.

Mike Hurley is the industry manager for Health Insurance at Hyland, helping health insurance organizations transform business processes that drive value for members, providers and employees. Mike works with current and prospective customers to use our award-winning product, OnBase, to drive business transformation. He is also responsible for our high-value, high-impact health insurance solutions, the like Mobile Medicare Enrollment Solution for OnBase. Prior to joining Hyland, he was the founder and president of Swim Lane Software, LLC. Hurley founded Swim Lane in 2007 to create a solution that leveraged Software as a Service (SaaS) technology to automate the processing and adjudication of Medicare Claims through unique use Business Process Management (BPM) and Business Rules Management Systems (BRMS) technologies. Preceding Swim Lane, he founded Green Square in 1997 as a national consulting practice that connected technology with business strategy. As a boutique services firm, Green Square was aimed at driving stakeholder value at over 25 BlueCross BlueShield plans in the U.S. Prior to Green Square, Hurley founded Avalon Technologies, Inc., an award-winning systems integrator focused on Enterprise Content Management (ECM), workflow and Optical Character Recognition (OCR) technologies.
Mike Hurley

Mike Hurley

Mike Hurley is the industry manager for Health Insurance at Hyland, helping health insurance organizations transform business processes that drive value for members, providers and employees. Mike works with current... read more about: Mike Hurley