A few years ago, a private liberal arts college in Vermont decided to reinforce the image of its campus, which features lots of quads and open spaces, as one that encourages students to do more walking. Concrete walkways were built over existing dirt-paths that the shoes of students and faculty had been shaping and re-shaping for generations. When the renovations were done, the local newspaper reported that fewer students showed up in class thereafter with muddied sneakers, though more of them were walking across the campus, even on rainy days. The new network of sidewalks, it seems, actually produced the desired effect of getting people to their destinations in more direct ways, on foot.
This simple concept, of adapting one’s facilities to accommodate the preference of users – who sometimes do vote (quite literally) with their feet – is one that can be aptly applied to initiatives aimed at improving services provided by government. Studies have shown that agencies at all levels of government are looking more and more to the Internet, to improve customer service.
From a customer perspective, a recent survey conducted by Hart-Teeter Research found that 74 percent of e-government users expect the Internet to have a more positive effect on government operations over the next five-to-ten years. If this signifies an expectation that services will soon be readily accessible via Web browsers, many if not most agencies should be intensifying their focus on e-Gov related services.
Perhaps the most universal (and general) expectation that people have of government, is that claims for government benefits or services will be acted upon in a timely manner. There are at least four implications of such an expectation:
- relatively easy access to a claims “agent”
- efficient processing of claims’ information
- fair and equitable adjudication of claims
- rapid disbursement or delivery of the resulting benefits and/or services
Appreciating the necessity of satisfying such customer expectations is the equivalent of understanding the need to build sidewalks where people like to walk. For each of the implications of processing claims in a timely manner, one or more best practices have been in use for quite some time already. A few examples of best practices most relevant to claims processing are reviewed below.
Single Sign-On (SSO) and Electronic Filing can do much to ease the claims filing process
One way of improving access to e-Gov services is to tackle the need for “single sign-on,” often called “SSO.” Another is to provide a mechanism for the electronic filing of claims data.
SSO provides an authentication method that would allow a given user easier access to more than one government service by entering the same username and password each time the Internet is used as the access channel, regardless of the agency contacted. To enable SSO functionality, other capabilities such as Identity Management and Access Control also need to be implemented, each of which requires the close management of security-related policies, persistent performance auditing, and a host of other monitoring and control mechanisms. More and more agencies at all levels of government are realizing that a robust Identity Management strategy must be at the heart of their initiatives to satisfy customers with differing needs via the Web.
Electronic Filing (or e-Filing) is gradually replacing the traditional method of filing claims for government services and benefits. Instead of duplicating, packaging, and manually delivering copies of documents to support a claim, e-Filing allows one to simply send it in via the Internet. As E-filing becomes increasingly popular among citizens growing accustomed to getting faster results from filing their tax returns that way, more and more providers of other government services will be compelled to meet that benchmark.
Workflow Management and Case Management can speed the claims-information processing
Once submitted, the processing of a claim for government services can be enhanced by an agency employing automated workflow capabilities that facilitate routing, exception handling, correspondence generation, alerts and notifications, and even the escalation of claims. Additional follow up with claimants may involve input via e-mail, fax or other means. Workflow management enables agencies to shorten cycle time, increase their productivity, improve customer service and reduce mistakes and administrative overhead.
Case Management functionality, on the other hand, can be applied to greatly facilitate the management of information related to a filed claim, while providing automated support for managing workflow and associated business processes. Agencies that can benefit from case management functionality extend beyond those providing legal services such as civil and criminal investigation and litigation to include those responsible for providing social services, healthcare services, loans and housing support, educational benefits, and many other government services. Web-based case management capabilities are proving to be the most innovative and effective claims management enablers now available to service providers, in both the private and public sectors.
Automated Business Rules Management can facilitate the equitable adjudication of claims
A business rules-driven service can be applied to support the approval or denial of claims at many agencies where the need to process them consistently has become increasingly important. Complex rules governing claims-handling processes can be cumbersome for well-meaning staff members trying to manage them using manual means. Even where rules are to some extent automated, they can be buried in customized code in numerous applications, which require weeks or months to effect needed changes to them. More and more agencies are now trying out business-rules engines, which can separate the business logic from claims-processing applications. In this way, rules can be managed externally and in parallel with other software services.
By managing rules outside of the application, a business-rules engine has the effect of enhancing agility. Rule maintenance is simplified, and the speed with which rules can be modified is greatly enhanced. This allows for more consistent claims processing, with fewer errors across all lines of business. It also has the effect of increasing customer satisfaction while also reducing “improper payments.” By implementing business-rules management services for claims processing, government agencies can significantly improve the level of service provided to their customers, while remaining agile in the face of ever-changing laws and regulations.
Electronic Funds Transfer services are the proverbial icing on the claims-processing cake
Electronic funds transfer (EFT) and electronic remittance advice (ERA) services are becoming increasingly essential to the efficient processing of claims. With EFT, agencies can send authorized payments directly to an individual’s (or to a third-party service provider’s) financial institution, thus offering a safe alternative to the issuance of paper checks. The benefits of EFT, which accrue to both the provider and the beneficiary of government services, include these:
- Elimination of the risk of paper checks being lost (or stolen) in the mail
- Faster access to disbursed funds
- Ready reconciliation of payments with bank statements
The electronic payment side of claims processing is yet to be adequately addressed by many government agencies. To complete claims processing with an electronic funds transfer and electronic remittance delivery to the provider would greatly improve the effectiveness of government service for both providers and payers, and result in cost savings as well.
Residual Points to Ponder
The concept of adapting government services to the preference of customers should not be difficult to realize. As we have just recalled, the technologies needed to streamline the processing of claims for government benefits are readily available in the marketplace, and have been for quite some time. The challenge is for agencies to make a fundamental commitment to do the right thing by their customers (to satisfy their expectations in a timely manner), as if there were serious competition for the services they offer – much as the U.S. Postal Service seems to have come to terms with its competition in the marketplace.
