By MICHELE IACOBACCI, vice president of information management and support, Mitchell Medical
One of the biggest mistakes in any insurance
software solutions training is if the vendor says, "See ya!" after the training and is never to be heard from again.
The problem with doing this is that most of the problems claims representatives encounter will not be in the use of the software itself but rather the effects of what the medical bill system may produce.
Now that the software vendor has prepared the carrier for the "how" part, post-training plans need to include the "what and why."
--What happens if the software fails?
--Why is my result on this EOB different that the result from the previous month?
--I can't respond to the providers question regarding PPO adjustments?
--What is a femur?
--What does "by report" mean in this case?
These situations can be handled in several ways; they are in order of preference
1. Design FAQs with the carrier as part of the initial based on the carrier and software vendors experience. FAQs will vary state by state due to compliance and regulatory issues.
2. Provide a post-training plan that will emphasize the typical scenarios that require retraining.
3. Schedule post training follow-up classes a "deeper dive" in subject matter, such as: What are the providers calling about? Why are claims representatives calling the vendor's customer service department?
4. Design a "Help Desk" plan whereby certain issues are handled by the vendor at the Help Desk or internal to the carrier. This should be done as part of the general workflow but reviewed in the post-training phase.
October 1, 2009
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