GVS leads into Eyecare benefits. Automated the intake process as well as credentialing process to minimize transition time with our Business Process Automation solution

Background

  • GVS leads into Eyecare benefits.
  • GVS offers services w.r.t. eyecare plans and eyecare products.
  • From 2 years they have been working closely with SVAM.
  • Since its inception more than 60 years ago, General Vision Services (TM) has been proudly serving more than 3 million members of unions, HMOs and corporations.
  • GVS continues to be a leading Eyecare Benefits Administrator and Preferred Provider Organization (PPO) provider of eyecare plans nationally.

Challenge

  • Earlier all stores setup and doctors credentialing process were done manually.
  • The new store request used to come in form a hard copy of NPR form, with which all details of the store are attached.
  • Management used to setup the store and process the approval request manually.
  • The doctors are attached to the stores and the credentialing process of the doctor was done manually.
  • This process being manual resulted into creating huge excel files and follow ups in emails and verbal communication.
  • This process was very time consuming, error prone and very difficult to manage. GVS was seeking for a comprehensive way for automating the current process.

SVAM’s Solution

  • SVAM built a web-based system named Nucleus for GVS.
  • Nucleus will be used by the front office to activate Stores under different Networks (GVS/VW/RCM) and thereafter credential the doctors with the various insurance plans.
  • The system is designed to automate the intake process as well as the credentialing process to minimize transition time from when a doctor / store requests to be validated against the insurance RCMs to when the stores can start taking claims against the insurance.
GVS Nucles Solution Architecture

Results

  • Nucleus automated 90% of the tasks which were manual.
  • Reduce manual user input and reduce the time for follow-up and approval of stores and doctors.
  • Nucleus helps in automating the complete workflow from Store web form, Approval, Doctor request from Store portal, and Doctor credentialing.
  • Nucleus provides historical data and other useful analytic data on the Home page itself, which enable the user to take the required pending actions.
  • Advance search functionality helps in finding the exact information which was previously not possible with Excel files.
  • Audit trail of exactly when the request came into the system and when it was completed.
  • Automating CAQH profile review and Initiating Verifpoint / Aperture applications.
  • Automating the contract sending process (DocuSign) for both Stores and Doctors.
  • Automating welcome letters both store and doctors.
  • Initiating a doctor’s request to be added to the system via new store portal system.
  • Updating GVS committee procedures and insurance companies with reports.
  • Sending out notifications & reminders for CAQH process, Verifpoint / Aperture, GVS Committee, Notifications to the team based on processes and statuses.