Bidding for a Clinic's Records Work
A 40-seat IT-ITeS vendor has been asked to bid for a clinic's records work. The clinic generates 40,000 scanned patient forms each month and wants two services: digitising insurance claim forms with 99.8% field accuracy, and 24/7 telephone appointment support. The vendor currently runs 20 voice seats at 85% utilisation and 25 non-voice seats at 60% utilisation; 15 staff are trained in medical coding, but only 8 are certified. The clinic's call peak is 6–9 p.m., and it insists that no patient data be stored on personal devices. The vendor's operations manager wants to accept the full 24/7 scope immediately to win the contract. The bid is due in five days, and the vendor cannot hire new staff before going live. The clinic has offered a 30-day transition window. What should the team recommend?
1. Recommend a service-delivery plan for the bid. Should the vendor accept the full 24/7 voice scope immediately? Justify using the capacity and accuracy data.
Read the worked answer
No - do not accept full 24/7 voice immediately.
- Voice capacity: 20 seats × 85% = 17 seats occupied, leaving only 3 free. A 24/7 service needs at least three shifts plus slack for breaks, leave and the 6–9 p.m. peak. Three spare seats cannot cover that, and hiring is not possible before go-live.
- Non-voice capacity: 25 seats × 60% = 15 occupied, leaving 10 free. Put the 15 coding-trained staff into a dedicated claims team; do not split them across voice.
- Accuracy: 99.8% on 40,000 forms allows only 80 field errors. Use two-pass entry for critical fields (policy number, amount, date) plus sampling QA for the rest, with validation rules.
- Recommendation: Bid a phased model. Phase 1: claims digitisation with a dedicated team and the 99.8% SLA. Voice starts at 12 hours/day using the 3 free seats and cross-training, with 24/7 as Phase 2 after recruitment. State the assumptions and service credits in the SLA. This wins the contract without overcommitting.
2. Identify three risks in your proposed plan and one control for each.
Read the worked answer
- Privacy breach through personal devices → ban personal devices in the production area; use locked-down desktops or VDI, block USB storage and keep an audit log.
- Accuracy miss on claims → two-pass entry for high-risk fields; 100% check of the first 500 forms, then statistical sampling; publish a daily error rate.
- Peak-hour failure at 6–9 p.m. → stagger shifts, cross-train five non-voice staff for voice, and set a written capacity trigger for adding seats.
- Certification gap → only 8 coders are certified; schedule certification for the other 7 and restrict complex codes to certified staff until then.
Each control has a measurable trigger, not just a policy statement.