The Ontario Health Insurance Plan (OHIP) pays for Hospital Emergency Room visits, and subsequent care, whether people have a Health Card or not. In cases where insurance is involved, these costs incurred are supposed to be paid by the insurer. For example a car accident victim may be rushed to hospital, and no one wants to have to haggle with an insurer at a time like that, even assuming you could reach an authorized person. Insurance companies are obliged to reimburse OHIP for those costs.
Historically, recovery of those costs involved a complex paper-based manual process, often involved legal work, civil trials, considerable medical research, copious amounts documentation, a lot of contact and correspondence detail, and long periods of time. This made organization, process and progress monitoring, and collection difficult. The picture is an exaggeration, but there was a lot of paper!
We created a digital documentation repository and a case management and workflow management system to manage the files. The system encompasses document intake, file routing (dealing with specialization, management requirements, etc.) scheduling, correspondence, timelines and problem escalation.
The system increased the monies collected, per-case average collections, and the number of cases completed per agent; reduced the case durations; and allowed management to assess performance based on collections, time parameters, activity levels, and other performance criteria such as contact frequency.
This project won the government IT manager involved the Canada Computing IT Manager of the Year Award in 2005.