Typical Implementation

Claim Status can be used for a range of customer applications:

• To date, Claim Status has been used primarily by both providers and members in the HealthCare insurance market.
• The application is equally applicable to other segments of the insurance market, including motor, home and travel insurance.
• Claim Status will usually be used in conjunction with Fluency’s IDVS application, which is used to identify the claim in question.

Key Features & Benefits

• Claim Status allows the caller to obtain the status of a claim without speaking to a call centre agent.
• In addition to advising the status of each claim, the Fluency application can also read back a range of information specific to that claim.
• Customer satisfaction is improved as the caller is able to monitor the status of a particular claim as it is processed.
• The time taken to capture the information is reduced, typically by 40 to 80%.
• Agent time is freed up to work on higher value activities.
• “Always On” availability allows callers to query the availability of their product 24 x 7.

Application Configuration

The Fluency Claim Status application can provide the caller with a range of information relating to the order, including:

• Four statuses can be returned to the caller: claim paid, claim received, claim denied or claim adjusted.
• For Claims Paid, the application can be configured to read back information on claim number, process date, Health Service Provider, total charges billed, amount paid, date paid, check number, patient share, co-payment and co-insurance details.
• For Claims Received, the application can be configured to read back information on claim number, receipt number, Health Service Provider and total charges.
• For Claims Denied, the application can be configured to read back information on claim number, process date, Health Service Provider, total charges and reason for denial.
• For Claims Adjusted, the application can be configured to read back information on claim number, process date, check number, patient share, co-payment, co-insurance, and adjustment date.
• Customers can choose the amount of detail provided back to the caller.
• Additional call flows can be set up in response to changing business requirements.

Deployment Options

Claim Status is a key application within the VSA suite. Fluency’s packaged speech recognition solutions are available On-Premise and Hosted, and have been successfully deployed for a range of customers across the US and UK.

Implementation & Support

Fluency provides a dedicated account team with overall responsibility for project implementation and ongoing support. An Account Manager, supported by a Technical Account Manager, provides the primary commercial point of contact. The Fluency Project Management Team guides the implementation through Project Initiation, Requirements Capture, Analysis and Design, Integration and Testing, and Implementation. Full training is provided covering Speech Recognition, Voice User Interface design, and Application Configuration. Post implementation, the Fluency Customer Response Center provides timely and dependable resolution of technical incidents. Fluency offers both “Business Day” and full 24 x 7 support.