Case Studies - Verity National Group

Customer Profile

Based in San Antonio, one of America's premier, multicultural cities, Verity National Group, a third party administrator specializing in data management and business processes, provides their customers with a wide variety of benefit options backed by the technology and speed of a much larger company. Verity National, which has served public and private employers for nearly 20 years, specializes in administering medical, dental, vision, disability and other insurance benefits while helping organizations practice self governance through state-of-the-art benefit plans.

The coordination of reinsurance, network, pharmacy, lab, wellness, disease management, medical case management, and pre-certification are all services that Verity National provides. They also consolidate online benefit eligibility and billing for group coverage. To provide their customers with consistent, quality service, they draw on five performance measures including: extraordinary personal attention, a passion for speed, uncompromised accuracy, technological strength and a team of experienced executives and employees.

The Challenge

In 2005, Verity National Group was spun off of a much larger company which had grown largely through acquisition. Verity National Group's executive team came together from diverse corporate backgrounds, where they shared one thing in common - a respect and understanding for the value of sophisticated technology. "We're big enough to provide customers with the depth of products and service they require, but small enough to provide a genuinely intimate relationship - something for which our team is regularly complimented," says Laurie Burke, president and chief financial officer, Verity National Group.

Prior to the spin-off, like many third party administrators, Verity National found themselves in need of a comprehensive claims processing solution. Two of the companies they acquired were licensing Acclamation Systems' LuminX solution, and when they ran due diligence on each of the systems, they found that LuminX was faster and more robust than both proprietary and custom-designed solutions.

"Claims processing comes down to time and money. As a TPA, we manage money for other people. When it's your job to make things flow, it's important to have a system that moves quickly and has the support of a strong company behind it," Burke says. Verity National needed a system that would allow them to cross train employees and to provide them the tools to work faster and more efficiently.

The Solution

Verity National Group cross-trains their employees because they realize that even the best processors cannot take customer service calls if their goal is to process 400 claims daily. By creating a comprehensive database of information and segregating duties, employees can focus on achieving their daily goals. Customer service reps have access to the customer's complete file, while processors can focus on claims. Verity calls it single call resolution. "All employees are cross-trained on duties and all information is cross-referenced on the screen. You'll never hear us say that we have to go retrieve your file or talk to a processor," explains Burke.

"We can accomplish more work with fewer employees," Burke reports. She says the equation is simple, "If we process more claims in less time, we don't need as many employees. Our overhead is less and we pass the savings on to our customers." She credits LuminX with providing the technology and speed, and her team with bringing a great work ethic. "When you combine these things, what normally can take ten days takes us a matter of hours. We don't have a backlog of claims. Our processors know that their day is over when the claims box is empty," she says. "We can't cut the check until it's funded by the client, but in most cases, we can promise that the claim will be scanned, adjudicated, processed and on the list for payment within one day."

The Result

Today, Burke is not afraid to make and live up to bold promises to her clients. "Our customers can select any day of the week, and they will get a request for funding on every claim we've processed in the past week. If a customer's RFF [request for funding / billing request] day is Friday, and we receive a huge batch of claims on Thursday, those claims will be processed in time to appear on Friday's RFF report," she says.

"Our employees can process about twice the number of claims as our competition, resulting in productivity measures we pass on to customers in terms of lower rates and cost savings," Burke says. "When a large hospital sees how quickly our customers' claims are paid, they may reward our faster service with increased savings on services to our customers. By working faster and more efficiently, Verity National can earn them greater discounts than the TPA down the street." To learn more about this customer, visit www.veritynational.com