Brochure: Transform your Operations with Workflow Plus

Nicole Driscoll

Transform Your Operations with HealthEdge Workflow Plus™

HealthEdge® understands the intricate demands of modern health plan operations. To address these challenges, we developed Workflow Plus™, a comprehensive workflow management solution designed to streamline processes, enhance collaboration, and significantly improve productivity.

Pre-integrated with HealthRules® Payer (HRP), Workflow Plus™ provides a real-time, transparent view of your team’s workload. It automates work assignments and employs advanced workflow management to optimize processes and increase efficiency, empowering your organization to achieve operational excellence.

Why Choose Workflow Plus™ for Your Health Plan?

Workflow Plus™ is engineered to deliver tangible results by addressing the core operational needs of health plans. Its seamless integration with core administration platforms like HealthRules® Edge simplifies user management and work queue setup, creating a unified operational environment.

Key benefits include:

Broad Support: Provides comprehensive support for a wide range of business operations.
Workload Management: Enables efficient workload distribution and management across multiple teams.
SLA Monitoring: Actively monitors Service Level Agreement (SLA) performance to ensure targets are consistently met.
Actionable Analytics: Delivers real-time data analytics, providing actionable insights to inform strategic decisions and optimize processes.

Modern, Automated Capabilities to Drive Success

Workflow Plus™ equips your team with modern, automated tools that reduce manual effort and allow staff to focus on high-value tasks and member care. Our customers have experienced a 10% to 15% increase in claims and enrollment auditing efficiency by leveraging these powerful capabilities.

Automated Processes and Workflow Management

Reduce manual tasks and minimize errors with automated workflow management. Workflow Plus™ automates work queuing and transaction routing to assign and prioritize operational tasks, freeing up your team while ensuring service level agreements are met with precision.

Enhanced Collaboration and Communication

Improve inter-departmental communication with tools designed for seamless collaboration. The system automatically directs tasks to the appropriate team members and offers flexible approaches for distributing workloads, keeping teams aligned and operating at peak efficiency.

Complete Visibility and Control

Gain unparalleled transparency with customizable dashboards and a complete overview of the entire audit workflow. The solution’s integration with HRP enables examiners and auditors to directly access claims to resolve edits and conduct audits, creating a frictionless process from end to end.

Streamlined Auditing and Compliance

Stay ahead of regulatory requirements with built-in compliance tracking features. Workflow Plus™ automates the entire audit process, from sampling to resolution, simplifying adherence to industry standards.

Auto/Manual Audit Sampling: Utilize preset automatic sampling rules or manual options for selecting audit transactions.
Audit Process Flow Management: Automate the end-to-end audit workflow, including Audit, Accept or Rebut, and Correct and Review stages.

Proven Outcomes for Health Plans

By implementing Workflow Plus™, health plans can achieve significant improvements across their operations. The platform is designed to drive success and deliver measurable results.

Outcome	Description
Improved Productivity	Streamlined processes lead directly to increased output and greater operational efficiency.
Improved Time Efficiency	Automating routine tasks allows your team to focus on high-value, strategic work.
Enhanced Transparency	Real-time views into operations foster accountability, trust, and better decision-making.
Automated Auditing	The simplified auditing process reduces manual effort, minimizes errors, and ensures compliance.
Better Collaboration	Enhanced communication and workflow tools encourage effective teamwork and process alignment.
Reduced Costs	Optimizing resources and automating tasks helps cut unnecessary overhead and expenditures.

To learn how Workflow Plus™ can transform your organization’s operational efficiency and drive success, visit healthedge.com to explore our solutions.