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Claims Processing - Disability Support Services |
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The Northern Regional Health Authority (NRHA) was the government organisation charged with purchasing Health & Disability Services for New Zealanders based in the Northern Region. The Disability Support Services Division (DSS) managed the disability budget of the NRHA. There were contracts in place with various disability service providers for the delivery of disability services and the DSS team managed and administered these contracts. One of the services was managed by the team in-house. This service had around 30,000 active claimants on its register and in terms of their entitlements stipulated by legislation, they were entitled to claim reimbursement from the NRHA of expenditure incurred by them on the purchase of certain items relating to disability services. |
The claims and reimbursement process was entirely manual and in view of the volume of claims was extremely time-consuming and in-efficient. An attempt had been made to convert the manual process to one managed via an Excel spreadsheet but that did not achieve the desired improvement in accuracy and efficiency.
Nous Consulting examined the requirements in detail and developed an application to record all claimants particulars and claim history so that the process of looking up the history of re-imbursements to a particular claimant was automated and the search and display time significantly reduced. Functionality was also developed to automatically calculate reimbursement limits based on the current rules and this resulted in vastly improved claim turnaround times and much better patient service. |
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| 1 pronounced like 'mouse' - an informal British term meaning common sense, or intelligence applied in a practical fashion http://en.wikipedia.org/wiki/Nous | ||