Automating the Capture Medical Claims Process – Not a New Concept, but Delivers Benefits

So what do you get when you take intelligent capture and medical claims mix them together? Simple…tangible benefits in the form of cost reduction and process efficiency.

For those who are not familiar with what a medical claim is and how it gets processed, think of  the last time you visited your physician or hospital. Following that visit a paper document (claim) gets generated which contains the medical billing information (e.g. procedure performed and amount being billed). The claim then gets submitted to an insurance company so that the physician or hospital can get paid.

CMS 1500 Medical Claim Form

CMS 1500 Medical Claim Form

Why Not transmit electronically?

In many cases, the information does get transmitted electronically but not all medical billing is done that way today and it will be some time before 100% of all medical billing is electronic.  So that still leaves insurance carries like a BCBS or third party payors with the problem on how to best capture and process the thousands of claims they receive each day.

Intelligent Capture is King with Medical Claims

There are many line of business processes you can automate with a document capture solution, but medical claims is one where the benefits standout.  The amount of data that needs to be extracted encompasses over a hundred fields (name, address, SSN, doctor ID, line item procedure and diagnosis codes, and so on).  By using OCR (optical character recognition) and applying business rules, a key part of the claims process can be automated, thereby eliminating most of the data entry that would occur otherwise.

Partners are Key

I like to think of this solution as a speciality that requires a software vendor and partner that know the medical claims process.  This is not your simple run-of-the-mill capture deployment, rather it takes a solution that has been proven over the years and a partner who has the skill set to deliver.

EMC partners like PaperFree, Paragon Solutions, and other EMC partners demonstrate that skill set. You can read about a recent win PaperFree just announced:

New West Health Services Chooses PaperFree Corporation to Implement Claims Processing Solution

Intelligent Data Capture Delivers

Intelligent capture for medical claims is key to solving what is often the bottleneck in the process where lots of data needs to be transformed into electronic informaiton.

The benefits can be significant, in fact cost and efficiency savings like 60% increase in overall productivity, 75% reduction in error rates, and 30% reduction in average claims processing cost are benefits that can be achieved.

So give it some thought.  Starting with the obvious challenges around automating the capture of medical claims data may be the way to go.



EMC Sponsored Research – New AIIM Study Reveals Investments in Document Capture Produces Rapid and Considerable Cost Savings in Less Than 12 Months

AIIM ROI paperAIIM just released a new study on document capture, that was sponsored by EMC. The research study shows that document scanning and capture is a very risk-free investment compared to other types of IT projects and payback time of the initial investment frequently occurs in less than one year.



Key findings from the study include:

  • 42 percent of organizations have increased productivity by 50 percent from their scanning and capture investment.
  • 43 percent have achieved payback within 12 months and two-thirds within 18 months.
  • Nearly half have achieved savings of 40 percent or more in paper storage costs.

A free copy of the study, “Extending Capture Capabilities – Measuring the ROI” is available at

What do you think?

  • Are you achieving the benefits from document capture that you expected?
  • Do you see opportunities to further expand the use of capture?
  • Is there  a need to replace a legacy scanning/imaging application in order to achieve greater benefits?

Feel free to comment back.

– Bill –

EMC Partner Wins State of Louisiana Contract – Complete Solution for Tax Processing

PaperFree Corporation is one of EMC’s top partners who delivers information capture and management solutions for business and government, which includes the Captiva Intelligent Capture products and solutions.

PaperFree recently announced that they won the State of Louisiana Contract to provide a complete solution for tax processing. Here’s a excerpt from the press release:

“PaperFree Corporation, the leader in information capture and management solutions for business and government, today announced that the State of Louisiana has officially awarded them a contract to provide the products and services for the design, development, implementation, testing, and training needed to provide a complete solution that improves remittance, return, data capture and imaging capture processes that support all functions within the Revenue Processing Center of the Department of Revenue (LDR).” You can check out the full press release on PaperFree’s web site.

This win demonstrates how government agencies and businesses continue to reinvest in their capture technologies (or replace old legacy imaging apps) to further drive down costs and improve process efficiencies. PaperFree has been doing business with LDR for quite some time now and LDR was looking to expand their capture operations. Specifically LDR was looking to expand their capture operations that would give them the ability to collect information closer to the source of origin, specifically from their remote field offices.

Through the use of EMC’s Captiva and Imagescan’s RemitTrac ™ (another EMC Partner), PaperFree presented a solution that met specified requirements created by LDR and also clearly demonstrated a path for future growth and expansion.  What PaperFree will be implementing is a  new processing solution that  will involve every aspect of the current operation from mail handling, remote capture (field offices), scanning, data capture, remittance processing, Check-21/ARC payment handling, integration to the GenTax™ System and complete operational reporting. 

The solution being implemented at LDR demonstrates how partners and EMC are able to bring technologies together to meet the needs of the customer. Partners like PaperFree and ImageScan help customers fulfill their requirements, while creating repeatable solutions that can be delivered to other government agencies and businesses.  Tax processing is one those repeatable solutions that EMC Captiva and its partners have been very successful in delivering for years.