Re-engineering a business model with a best-in-class claims processing system

In 2002, Washington Dental Service, the leading dental benefits company in Washington, needed to transition its existing Legacy Open VMS COBOL system to a more scalable, supportable hardware and software environment.

DeCare Systems Ireland used its extensive expertise in the health care industry to develop an overarching, real-time claims adjudication system that will drive the future business model for WDS.

Using Microsoft ASP, SQL Server 2000, Visual C++ and Visual Basic as the key technologies, the system was developed in parallel tracks, each addressing specific business needs. The system also was developed to maximize the real-time connection to the NPF database of current national provider billing rates and information for dental health professionals throughout the U.S.

The new system allows for the interactive adjustment of business rules and parameters and is refreshed daily with updated eligibility information. As a result, data is more timely and accurate, which will significantly reduce claims administration and underwriting costs:

• Since its launch, the system has achieved greater than 98 percent uptime.
   
• The drop-to-pay rate has increased to 66% from 43%. This is a significant increase in the ability to process claims for payment without manual intervention, thus reducing administrative costs and increasing the speed of payment.

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