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It’s All Smiles at California’s Largest Dental Health Plan Thanks to Sub-Second Access to Enrollee and Provider Documents

Market Leader Goes Big with Alfresco

Delta Dental of California (DDC) is the state’s largest dental health plan with more than 25 million enrollees and 106,000 dentist locations. A member of the national Delta Dental Plans Association, the San Francisco-based company leads the market by limiting out-of-pocket costs and simplifying its claims process. Strategic investments in technologies like enterprise content management are critical to making DDC’s dental plans affordable and easy to use.

DDC first adopted Alfresco Content Services in 2014, selecting the modern, open platform over IBM FileNet for its scalability, flexibility and easy upgrades. Three years later, DDC has integrated Alfresco into numerous business-critical processes, including claims processing; group sales, underwriting and enrollee onboarding; and provider credentialing and onboarding.

“Alfresco is a critical application for DDC for managing documents for enrollees, dentists and internal business applications,” says Mahesh Kadarkarai, Applications Manager and Architect.

132,000 Documents Added Daily

Insurance is a high volume, document-intensive business, especially when it comes to claims processing. In 2016, DDC processed 29.4 million claims and generated 36 million claims-related documents—all of which are ingested and managed by Alfresco Content Services. DDC’s 6 TB enterprise repository contains 318 million documents—with another 132,000 documents uploaded every weekday.

DDC uses Alfresco Content Services to improve the claims experience for both patients and providers. Alfresco is integrated with DDC’s Enrollee Portal so patients can easily look up explanation of benefits (EOB) statements and other claims information from a desktop or mobile device. Integration with DDC’s Provider Portal allows dentists to submit claims and digital attachments online for faster adjudication and payment.

DDC has also connected Alfresco with its contact center application to enable prompt, responsive support and shorter call times. Customer service agents simply click a link to access Alfresco Share, where they can quickly retrieve documents while on the phone with patients and providers.

Sub-Second Response Time

Performance at scale is imperative in DDC’s demanding, high volume environment. “The first criteria for us is performance,” says Kadarkarai, “which we’ve been able to achieve with Alfresco.” In early implementations, DDC worked closely with the Alfresco team to do performance testing and tuning. Now “Alfresco delivers a sub-second response time which allows us to quickly respond to customer requests,” according to DDC’s manager of business support services. “Our overall experience with Alfresco has been positive.”

DDC leverages Alfresco’s robust metadata support, indexing and Solr search services to speed the retrieval of relevant documents. In the contact center, Alfresco’s highly granular search capabilities allow agents to search by document category, document type, account number, customer name, zip code, date range and check number. “We can further refine the search result by quantity which is helpful when assisting large dental practices,” says the business support services manager.

Integration with Salesforce

DDC has modernized multiple content-rich processes by building solutions that combine Alfresco Content Services with other business applications. “The ability for Alfresco to integrate with other systems is key for us,” says Kadarkarai. His team has taken advantage of the platform’s CMIS REST API to accelerate solution development and make documents accessible from within the applications people use every day.

For example, as part of its “Prospect-to-Enrollee” transformation project, DDC integrated Alfresco Content Services with Salesforce, the cloud-based sales automation solution. A custom-built embedded iframe allows the Group Sales team to find, view, share and upload documents without leaving Salesforce. Document integration is at the Accounts and Opportunities object level. (Kadarkarai says an evaluation of the new Alfresco Content Connector for Salesforce is on his to do list.)

Integrating Content and Process

DDC has also integrated Alfresco Content Services with their existing BPM and case management platform to transform workflows in group underwriting and onboarding as well as provider credentialing and onboarding. “We’ve done a seamless integration with Pega,” says Kadarkarai. There is a window for document lookup in the Pega interface, “but behind the scenes, it’s really Alfresco.”

By integrating content and process, DDC can reduce the time required to approve and onboard new commercial accounts and dental practices—a huge benefit for a company that saw provider recruiting costs increase by 50% over five years. It’s also easier to share documents across user groups—sales, underwriting, enrollment, billing, finance, etc.—which eliminates repeated requests for the same information.

More Use Cases on the Horizon

DDC has been on a successful three-year journey with Alfresco. Looking ahead, Kadarkarai sees many more opportunities for document migration and integration with Alfresco Content Services. Projects on the roadmap include implementing Alfresco in DDC’s Individual line of business and integrating Alfresco with Oracle E-Business Suite (and migrating off an NFSmounted filesystem) for greater operational efficiencies.

According to Kadarkarai, his customers are happy, so he’s happy. “I couldn’t think of anything but Alfresco for us now,” he says.

“Alfresco delivers a sub-second response time, which allows us to quickly respond to customer requests. Our overall experience with Alfresco has been positive.”

Mahesh Kadarkarai, Applications Manager and Architect

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