Industry Case Study: Healthcare Administration

While ProWorkflow isn’t broadly used for managing services and patients directly within hospitals (yet!), we are used in certain administrative capacities within the healthcare industry. Specifically when it comes to connecting insurance companies with patients and healthcare providers,  ProWorkflow has seen some success with companies all over the world. Here we can talk about some of the problems these administrators can face, and how ProWorkflow makes overcoming them much easier.  

Complex Multi-Stakeholder Communication 

• Problem: Coordination between patients, providers, insurers, and administrators is often fragmented. 

• Cause: Disparate systems, data silos, and unclear accountability. 

• Impact: Delayed authorisations, billing errors, frustrated patients, compliance risks. 

When your discussions span across so many different groups with their own standards and expectations, keeping information centralised and everyone informed is difficult. Clients that use ProWorkflow tend to use it as the core source of truth; when a new claim begins its lifecycle, ProWorkflow is the first place it will be logged. From there, all different stakeholders can be involved and assigned, so everyone knows their precise responsibilities and when those obligations need to be met. This isn’t just for the claims system or the healthcare provider, but for the patient too! Forms can be uploaded, and questions can be asked all in ProWorkflow. Instead of hunting through three different email accounts to try get updates on a certain claim, everything is stored in ProWorkflow and finding information/updates is a very straightforward process. 

ProWorkflow also features a messaging system that links directly with emails. This means responses can be made with an external party, with messages being logged within ProWorkflow that were not created in ProWorkflow. If you need to reduce confusion for any stakeholder in the process and training them in the use of an online portal is not efficient or timely, you can reap all the benefits of centralised communications while your client only has to check their emails. 

Also of benefit is ProWorkflows free support and training, meaning at the very least adopting the platform will come with the assistance of our talented training staff, and your staff will have the benefit of a constant source of support and helpful info.  

Billing and Claims Errors 

• Problem: Inaccurate or incomplete claims lead to payment delays or rejections. 

• Cause: Human error, inconsistent coding practices, or incomplete documentation. 

• Impact: Revenue cycle inefficiencies, patient confusion, strained provider relationships. 

Again, this issue is something that can be dealt with via ProWorkflow’s centralised data system. You’re much more likely to know what data is missing on the basis of seeing that a certain process has not been updated/completed in ProWorkflow, or that a field is outright missing. This is to say, by using ProWorkflow you’ll largely be catching these errors before they become an issue. By standardising processes, you’ll ensure that a lack of data is never responsible for a missed payment, and subsequent hardship faced by your client who may see their care delayed or otherwise. 

Inefficient Data Management 

• Problem: Patient and provider data exist across multiple incompatible systems (EHRs, billing software, insurance portals). 

• Cause: Lack of interoperability and data standardisation. 

• Impact: Duplicated records, claim denials, slower care coordination. 

Because so much information is generally required AND it tends to be required by many different organisational bodies that all have their own compliance requirements, having one source of truth can be very helpful. ProWorkflow can template the processes and procedures required at every step of the way. Whether you need multiple processes for each organisation you interact with, or each claim or each patient, we can store a repertoire of processes that ensure whoever’s is logging the claim knows exactly what information needs to be collected and what steps need to be followed. This includes who needs to be informed! ProWorkflow has non staff licenses that come free of charge, and these ensure that all relevant stakeholders receive notifications of each new update. The messaging system works via email here too, so these notifications can be made without users expressly needing to log in to the tool. This means the chances of them seeing the change as it gets made go up greatly, which promotes faster processing times. 

This covers your interactions in ProWorkflow, however you may be wondering about all of the system external to ProWorkflow that need to be updated. ProWorkflow features an open API, meaning with some light coding, interactions can be created between systems. For instance, a client’s claim is updated in ProWorkflow, this then creates a ping that goes out to your CRM and shows a similar update to the corresponding field there. We also connect with services like Zapier, meaning you can create these API calls without any coding being required. This is all to say that treating ProWorkflow as your main source of truth comes with no downsides or double entry; ProWorkflow is capable of automatically talking to any systems you may currently be using.  

ProWorkflow wasn’t initially built to interact with the healthcare industry, however our data control, centralised data collection, and ability to deal with several stakeholders, processes and documents per project makes it a perfect match. Healthcare administrators all over the world have seen success in adopting our platform, and integrating it with their suite of tools. If you think you might also benefit from any of the perks listed above, be sure to get in touch and we can discuss how ProWorkflow might work for you.