Wednesday, December 4, 2013

Business Process Management, Document Management and Document Capture

I wanted to begin this post by thanking our partner Digitex for sharing their experience with Athento with us yesterday, and by thanking the dozens of participants who joined us yesterday, in spite of the mixup with the time. It’s always a joy to see how Athento’s webinars fill up.

Right: let’s get to the subject at hand. Today, I’d like to share the presentation that we used in yesterday’s webinar. For those of you who weren’t with us, I’ll provide you with a quick summary of the case study that we presented yesterday. 

Client: Insurance and Work Safety Administrators, Colombia. 

In accordance with the Colombian labor system, a company like this mainly focuses on:

  • Affiliating workers to the Work Safety System.
  • Collect the contributions of workers in the System.
  • Guarantees that affiliated workers will be able to access health care services.
  • Carry out workplace safety and accident prevention programs.
Businesses in Colombia then select an insurance company that offers these programs, and pay the insurers to cover the health needs of their workers when there are work-related incidents. That means that any worker who suffers an accident or illness related to work has his or her medical expenses covered by this kind of insurance company.
These insurers, however, don’t provide health services directly: they work with a network of health care providers who provide services related to:

  • providing medical, surgical and therapeutic assistance
  • hospital stays
  • dental care
  • supplying medication
  • diagnostic services, etc.
So, to sum up, a worker who’s covered by one of these insurance companies and who has an accident goes to a clinic that’s authorized by his insurer and receives the necessary medical treatment.

These health care facilities certainly don’t work for free: after the worker receives treatment, the facility then generates an invoice to be paid by the insurer.

Problem: A large number of invoices need to be processed, and there needs to be guarantees that the invoiced amounts for the insurance company meet certain pre-established fees. This involves arduous, expensive manual labor; the idea was to automate the process.

Solution:  Design a system that unites document management, capture and account auditing. The Digitex Group, experts in Business Process Management, designed a system that worked in the following way: 

  1. Digitizing invoices: Invoices can either be medical or for services.
  2. Data Extraction: Athento’s capture module extracts the necessary information (service provider, amounts, etc.) from the invoices.
  3. Sending data to Auditing application: Using web services, the capture application is connected to the Auditing application, to incorporate the invoices, and the data extracted from them. 
  4. Auditing, approval for payment or withheld: The Auditing application developed by Digitex is in charge of applying rules to decide if the companies providing services are charging the correct amounts. If so, payment is approved. If not, “withholding” documents are generated that show the justifications for, and explain the reasons why, payment was rejected.
As this process is taking place, invoices are stored for safekeeping in Athento’s document management module.



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