Healthcare Competency Overview

10th May 2011

Corporate Overview

3

About HGS

• Global provider of BPO and customer support solutions

• 37+ years, 250 M calls, 40 M claim transactions per year

• 107 clients, 20,000+ employees, 7 countries, 32 Centers

• $240 million in revenue , Listed Company, S&P CRISIL- AA

• ISO 9001, ISO 27001, HIPAA, GLBA, PCI, eSCM (2012)

Services Where And When You Need Them

USA Canada PhilippinesIndia MauritiusU.K. Jamaica

4

Industries

Healthcare and Insurance

Telecommunications

CP, CG, and CE

Logistics, Transportation, and Others

Banking and Financial Services

Diverse Industry Experience

5

Key Business Drivers

Committed People, Defined Processes, and Cutting-Edge Technology

People

Process

Technology

• Agent Partnership Approach• Tenured global management teams• Bridging Emotions & Economics with local leadership

• Business Excellence (BE) – Dedicated organization• Cross-functional process enhancements – AIM, SPARK• Compliance – HIPAA, SAS 70, GLBA, ISO

• World class and flexible solutions – PMS Systems• Scalable across HGS’ global locations – Inter connected• Secure – Serving data security needs of large payors

6

Industry Recognition

Winner: Most Innovative BPO in 2008

Philippines

Top 10 Employers Employee Satisfaction /

HR Practices

1 of 200 “Best Under a Billion” Forbes Asia

October 2005

Gold MedalistCompetency Development

Gold Medalist Competency Development (2008, 2009, 2010)

Seal of Product Quality National Product Quality

Excellence AwardAugust 2005

Top 20 by Industry Focus – Healthcare

Top 10 – Services Offered Top 10 – By Region Served

Gold Medalist Lean Six

Sigma

No. 30 in the Top 50 Fastest Growing Companies in India 2009

Technology Fast 50 India 2009

No. 16 in the Top 20 BPO Employer for 2010

Top 15 ITES BPO Exporters FY 10-11

One of the Top ITES Companies in India

7

100

75

50

25

50-55%

75.7%

+100

+75

+50

+25

+40-45

+62

4.8-5.5

5.8

7

6

5

4

3

2

1

6

5

5.6

5.69

5.96

5.7 5.7

5.86

5.1

5.56

Industry Average Vs HGS Industry Standard Vs HGS

HGS HealthcareEngagement to

Excellence

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Payor Expertise

Member Services

Provider Services

Plan Sponsor Services

ClaimExperience

40 Million Claims

High Dollar & Complex

HCFA / UB04

Claims

Calls Experience

Member Calls – 1.5

Million Calls

Provider Calls – 6.5

Million Calls

Operational Expertise

1st in Quality -

All Delivery Centers

99.8% Pay Incidence Accuracy

Compliance

HIPAA

SAS 70

GLBA

Process Enhancements

All Ideas Matter -

AIM

Diet Six Sigma

Sharing Best

Practices - Spark

People& Tenure

200 claim Associates

at 100% QA in 2010

Average Leadership Tenure

of 7 Years

Over a Decade of Healthcare BPO Experience

Scalability

Annual Growth of 60% for Last 10 Years

Blended Shoring

DR & BCP

2000

2011

HGS Healthcare Overview

E n g a g e m e n t E x p e r i e n c e E x p e r t i s e E x c e l l e n c e

Performance Management

System

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Payor Services Data Transaction

Onshore Calls Function

Plan Administration and Support

SalesSupport

UnderwritingSupport

Plan LoadingAnd Setup

Plan Testing

BillingPremium

450 FTEs

Claim Services and Support

Mailroom andScanning

Claims DataEntry

ReferralEntry

Claim Audit & MedicalTriage

Claim Payment& Review

2100 FTEs

Provider Services and Support

Provider Correspondence

Provider Customer Service

Provider Network Calls

Pre- AuthorizationCalls

Claim Rework Unit

900 FTEs

Member Services and Support

Benefit andEligibilityCalls

Claim DisputeCalls

PremiumPayment

Plan Renewal

WellnessCareSupport

300 FTEs

Research andRecovery

OverpaymentValidation

OverpaymentRefundRequest

OverpaymentRefundPosting

FraudResearch

RefundCalls

500 FTEs

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Perfect Service – Journey and Milestones

DRC`

Network Mgmt

Delegated

Correspondence

SIU

Under and Over payment

Provider Investigations

Dental FR

19 Processes

Product Implementation

Claims Research / CORR

Underwriting (UAS)

Account Receivables

Case Review Entry

Clinical intake & Provider Loading

Wellness & Point of Care

Fulfillment center

IT infrastructure support

New Business Quoting

34Processes

Batch Suspended Inquiry

Special Projects

Provider Calls & Individual Plans

Dental Claims Rework Unit

Cash Posting

21 Processes

Provider CallsMedical

(Level 1 and L2)65 FTEs

275FTEs

450 FTEs

1820 FTEs

850 FTEs

5 Processe

sProvider Outreach

Medical Claims

Certificates

Dental Claims

2003- 2004 2005-2006 2007-2008 2010 - 20112009

Bangalore Bangalore Bangalore /Chennai India / Philippines India / Philippines/ US

Legacy Platform Mainframe / Windows Platform

Legacy Platform/Mainframe Platform

Legacy Platform/Mainframe / Windows Platform

Mainframe / Windows Platform

Claims Administration

Eligibility Check Process

Counter Mgmt

Plan Testing

Dental Claims

11 Processes

Product Build

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Define To reduce the Reroute of claims and thereby reduce cost of claim processing

Measure and Analyze

Percentage of reroutes were measured during transition The categories of edits and reasons were tracked and analyzed

Improve

Incorrect duplicate edits were identified and eliminated Provider function edits and errors were identified and process improvement were recommended Reroutes because of skill set gap were identified & team was trained to eliminate the reroutes System up gradation issues were tracked, and therefore errors reduced

Control

The reroutes reduced from 31. 4% to 0.11% The edits were continuously monitored to identify opportunities for improvement and process

improvement solutions recommended

Impact

Example 1 - Claims Adjudication

Re-Routes Reduction from 31.4% in Dec 2005 to 0.11% in Jan 2011

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Example 2 – Special Investigations Unit

• Purpose and Objective : To reduce documentation errors and standardize the process

• The Challenge: Incorrect documentation

• The Solution: A documentation tool was developed

• Benefit: Tool has been adopted by the client

0

10

20

30

40

50

60

70

80

Jan Feb Mar Apr May Jun Jul

72

34

13

5 3 3 2 2 2

Task element documented Letter Verbiage correct Task created correctly

Correct Letter Sent Letter sent Other

Denial Code Correct Remarks created correctly Task result correct

Jan ’09

~50%Errors due to

Documentation

Jan ’09 to Jul ’09

72 Errors Reduced to 0

Improving Performance with Focused Process Improvement

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Example 3– Product Build• Purpose and Objective : To automate the initial phase of rider mapping before loading to Dynamic Plan Load.

• The Challenge:

Manual work

Cycle time

Dup Accumm Errors

Complex process logic

• The Solution: “Rider Mapping Automation Template ” was developed

• Reduction in Cycle time

Prerequisites39 mins

COC CR 28 mins

COC NP CR PAR

32 mins

PLYR CR 20 mins

PLYR NP CR PAR

30 mins

Cycle Time 149 mins

Prerequisites39 mins

Automated Output30 mins

Cycle Time 69 mins

Reduction in Rider Mapping Issues from 83.72% to 12.5%!

Business Excellence

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Business ExcellenceAssurance Control Improvement

Organization CapabilityGroup

Compliance and AuditGroup

Quality Group Continuous ImprovementGroup

• International Standards and Regulations

• Risk Management

• AIM – ALL IDEAS MATTER

• Diet Six Sigma

• Six Sigma Projects

• QPEP — Quality Professional Excellence Program

• Excellence Frameworks

• Perception Management

• Brand Building

• eSCM / COPC

• 5 Business Methodologies

• 250 Processes, Practices and Procedures

• SPARK — Best Practices Repository

• 360 Available Practices

• 6 Papers Published in National and International Forums

• ISO 9000, ISO 2700, HIPAA, GLBA, SAS, PCI

• 2300 Risks and 2500 controls in place

• Internal Auditor program developed, 18 internal auditors trained

• 2 Internal Assessments and Audits • 2 DR Test completed

and reported

• Operations Quality

• Transition Quality

• Shared Services Quality

• Quality Tools and Macros Development

• Quality Forum

• 1000 Operational part of Central repository

• 25 accounts transitioned

• 250 Metrics part of Shared Services

• 100 Automation tools tracked

• 2600 Ideas, 240 Ideas Implemented

• 350 People trained on Diet Six Sigma

• 30 BB Trained

• 60 Projects , 7 completed

• Total saving of $200 K

• 300 QA trained and 75 certified till date

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Continuous Improvement

QPEP SPARKConceptTraining

Let’s TalkExcellence

PerformanceImprovement

ProductivityTools

ProcessChanges

FinancialBenefits

BusinessGrowth

Voice of Process

BusinessFeedback

Voice ofCustomer/Client

AIM (Kaizen)

PCS

8-D

Diet Six Sigma

Six Sigma

Lean

DFSS

TRIZ

• Idea Generation and Processing Tools• Seven Basic Quality Tools• Seven M&P Tools• Decision Making Tools• Project Management Tools• Statistical Tools

• Lean Tools

• DFSS Tools

• Innovation Tools

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AIM – All Ideas Matter

• New Ideas: 483 feasible ideas from 2600

• Implemented: 240 of these ideas have been implemented

• Key Impact Ideas:– Reduced rework errors by 40%– Improved CSAT on a Telecom engagement

by 4% within 1 month of implementation– Patient appointment errors reduced by

50% in 4 months– Errors in claim adjudication reduced by

28% in 3 months

Key Improvement and Business Impact

Questions and Answers Wrap-up and Next Steps