SVAM Case Study of GVS Eyecare Business Process Automation solution

Overview

GVS leads into Eyecare benefits.
GVS offers services w.r.t. eyecare plans and eyecare products.
From 2 years they have been working closely with SVAM.
Since its inception more than 60 years ago, General Vision Services (TM) has been proudly serving more than 3 million members of unions, HMOs and corporations.
GVS continues to be a leading Eyecare Benefits Administrator and Preferred Provider Organization (PPO) provider of eyecare plans nationally.

Earlier all stores setup and doctors credentialing process were done manually.
The new store request used to come in form a hard copy of NPR form, with which all details of the store are attached.
Management used to setup the store and process the approval request manually.
The doctors are attached to the stores and the credentialing process of the doctor was done manually.
This process being manual resulted into creating huge excel files and follow ups in emails and verbal communication.
This process was very time consuming, error prone and very difficult to manage. GVS was seeking for a comprehensive way for automating the current process.

SVAM built a web-based system named Nucleus for GVS.
Nucleus will be used by the front office to activate Stores under different Networks (GVS/VW/RCM) and thereafter credential the doctors with the various insurance plans.
The system is designed to automate the intake process as well as the credentialing process to minimize transition time from when a doctor / store requests to be validated against the insurance RCMs to when the stores can start taking claims against the insurance.

Nucleus automated 90% of the tasks which were manual.
Reduce manual user input and reduce the time for follow-up and approval of stores and doctors.
Nucleus helps in automating the complete workflow from Store web form, Approval, Doctor request from Store portal, and Doctor credentialing.
Nucleus provides historical data and other useful analytic data on the Home page itself, which enable the user to take the required pending actions.
Advance search functionality helps in finding the exact information which was previously not possible with Excel files.
Audit trail of exactly when the request came into the system and when it was completed.
Automating CAQH profile review and Initiating Verifpoint / Aperture applications.
Automating the contract sending process (DocuSign) for both Stores and Doctors.
Automating welcome letters both store and doctors.
Initiating a doctor’s request to be added to the system via new store portal system.
Updating GVS committee procedures and insurance companies with reports.
Sending out notifications & reminders for CAQH process, Verifpoint / Aperture, GVS Committee, Notifications to the team based on processes and statuses.