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.

-Bill-

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