Tuesday, November 24, 2009

The Defects Are in the Tools, Not the People

The two most common mistakes we made in the call center/claims group were paying at the wrong level (we had four levels of payment, depending on the credentials of the provider) and paying the wrong provider location. It was easy to make mistakes in these areas. We had to choose the pay level in the second screen of the claim entry, while the provider level only displayed on the first screen, so we had to remember what it was when we got to that field. The provider address didn’t show in the claim at all. In order send the check to the right location, the person who entered the referral, days or weeks before, would have had to pick it correctly when they set it up. Since the referral didn’t always go to the same address as the claim check, this made paying the claim to the right location something you hoped for rather than knew.

Doing the Right Thing
and Achieving All Your Goals at the Same Time



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