Sales Order Management

Overview 

In the Life Science industry, the Sales order creation and maintenance process for medical equipment varies from a simple to a very complex process where patient, patient’s contact persons, different providers, and several health insurance organizations are involved in the sales order life cycle and influence the process. Further, the sales order process changes significantly depending on whether it is a rental or a retail buy order for a home care patient or for any facility. Also, the different kinds of medical equipment, used for different types of treatment, require different types of medical qualification check, payer authorization or medical necessity confirmation and documentations. In simple terms, there are many variables and parameters involved around a sales order process of any medical equipment.

Some of the key business problems, faced by the medical equipment suppliers are:

• Lack of end-to-end visibility into the sales order management process where patient, different providers (Prescriber, Caregiver, PCP, Referring MD), insurance organizations (Payers) get involved and influence the process outcome.
• Adhering to payer guidelines and compliance which vary from payer to payer and the health condition of the patient.
• Early detection of disqualified orders based on specific payer rules
• Tracking and follow up of must have information and documentation to support each sales order case.
• Confirmation of future payments and tracking the authorization period which varies by case.
• Missing out sales revenue for disqualified cases which can be resolved via appeal or clinical review
• Faster delivery of the product to the patient in need
• Keep track of claim status, policy status etc for seamless payments and collections

Key Features & Functionality

Coforge have developed an innovative solution to address the aforementioned business challenges, leveraging the power of the Appian platform as the foundation. The solution is scalable and can be extended to external business systems to accommodate all parties involved and expanded to different process variants to support dynamic case management. The solution is entirely configurable, flexible and customizable to support any types of device sales order namely - Homecare Rental, Facility Rental, Facility Retail Buy, Charity Care, Private Pay etc. The sales order solution can be configured for any types of medical devices which requires different types of patient medical criteria qualification check and supporting documents. The business users can introduce a new Medical Criteria Questionnaire which is more suited for their business need or decommission existing medical criteria check without any coding involved. They can further configure, add or update Payer related rules in an admin console which will govern the sales order process. The entire solution is built to enable and empower the business users to configure and manage their own sales order process as per their business needs. The solution will function as a one shop stop for all types of sales orders.

Following are the key differentiating factor of the solution:

• Low Code solution template can be extended to external parties, expanded to any process variations or reduced to a smaller process flow as per the business need.
• Application manages multiple parties involved in the sales order process.
• Holistic view of sales order data in one UI for better informed decision making.
• Ready made extension points for external integrations
• Built-in support for any process variations
• A configurable solution to accommodate different types of sales orders
• Manage specific payer guidelines to ensure faster payments
• Ensuring compliance with HIPPA

Benefits & Business Impact

• Streamlined sales order creation process
• Improved operational efficiency for contact center and order processing teams through automatic tracking of data and document requirements
• Efficient and compliant data capture through automatic data validations
• Faster turn around times for releasing orders
• Maintain adherence to regulatory compliance such as HIPPA and specific payer rules
• Early detection of disqualified orders and managing those through to resolution
• Revenue assurance for every order by securing authorizations and approvals from payers
• Flexible solution to accommodate multiple parties as needed
• 360 view of sales order process for faster and informed decision making
• Real-time tracking and monitoring of each sales order