Non-profit health insurer

Health Insurer Automates Claim Processing with Taskmaster Medical Claim

Published on 31-May-2011

Validated on 01 Mar 2013

"Taskmaster Web enabled us to expand our customer service benefits to include easy access to all information on the Web. Like most companies we are ‘web enabling’ applications that make sense to improve our customer relationships." - Senior LAN Administrator

Customer:
Non-profit health insurer

Industry:
Healthcare, Insurance

Solution:
Enterprise Content Management

Overview

Health Insurer Automates Claim Processing with Taskmaster Medical Claims Capture

Business need:
If a customer called with a question, it took 24 hours to retrieve the microfilm and print a hard copy. Often it could take several return calls to get a claim inquiry resolved.

Solution:
Datacap Taskmaster Medical Claims Capture receives the images, applies dual OCR recognition and passes them through a series of validations, claims are reviewed using the verify screen, to highlight low-confidence characters for fast repair.

Benefits:
Claims processing productivity has tripled. Now, all claims are going through the Taskmaster system and operators are processing more than over 1.1 million claim images a month.

Case Study

A non-profit health insurer, with more than 2,000 employees, has fully automated and streamlined its entire medical claims processing system across all of its offices, due to the deployment of Datacap Taskmaster Medical Claims Capture integrated with a Global 360 Imaging and Workflow solution.

The Challenge

The Payer’s claims staff and IT department used to process a vast amount of claim data manually. Significant time was wasted organizing files, entering data and fixing the numerous mistakes that are inevitable when paper is the primary information source. The need for collaboration among the Company’s three offices aggravated a complexity that made providing efficient customer service a challenge.

Another challenge is a relatively small support staff for IT and Imaging projects. The company needed a solution that would essentially “run itself” after implementation and not require a lot of maintenance and delicate handling.

The Solution

With more than 2,000 CMS 1500 claim pages and attachments arriving in the mailroom every day, management decided to make the transition to claims automation. After a rigorous investigation of several vendors, they selected the IBM Datacap Taskmaster Medical Claims Capture scanning solution. Taskmaster works in conjunction with Kodak scanners and delivers captured data to a Facets adjudication system and indexed claim images to a Global 360 image management solution. The objective is to streamline the flow of information, sped claim processing, eliminate unnecessary paper handling and manual data entry, and improve customer service.

The streamlined process dramatically simplifies claim payment. First, paper claims are organized into batches by mailroom staff and fed into the Kodak scanners. Taskmaster Medical Claims Capture drives the scanners and pulls images into the capture solution for processing. Next, Taskmaster applies optical character recognition (OCR) technology and identifies the field locations to extract the required data from the claims. After recognition, a series of automated database lookups, help assure data accuracy. By comparing captured data against a database, the system can confirm that the member number corresponds with the name, the CPT codes with the diagnosis, and the zip code with the city, and so on.

Once the medical claims captured and validated, they are shown to a verify operator. If any field fails validation, it’s highlighted in red, making it easy for operators to correct with a keystroke. If characters are inaccurate, switching a 9 for a 4, for example, which can happen if paper claims are printed too light (or too dark), the operator can make changes on the spot.

The Insurance payer was one of the first Datacap end users to understand the benefits of Datacap’s browser-based verification, and they found a unique way to use it. Usually, browser-based capture is used in distributed applications to enable scanning or verification anywhere in the world. But this organization wasn’t interested in distributing capture over a dispersed area. They were interested in making administration easier for their already overworked IT resources.

By setting up the claims department’s six verify stations as browser-based clients, the company simplified management of the system. Verify operators simply launch their browser at the start of the day, sign in to the Taskmaster web server and enter their password. No software needs to be installed on each client. Any changes or updates are made to the Taskmaster web server. Setting up a new employee is as simple as selecting the appropriate permissions and a password. An added benefit is that Taskmaster tracks when verify operators sign in and sign out. System administrators still have access to productivity reports and can monitor batches of work on the Taskmaster Web Job Monitor just as they can in the thick-client version.

Once verified, claim data is forwarded in HIPAA-compliant 837 EDI format to an IBM WebSphere Transformation Extender (WTX) system, which translates the data, along with incoming EDI from healthcare providers, into the format required by the Facets adjudication system. All claim images are uploaded to the Global 360 system, along with indexes, for efficient storage and retrieval by customer service representatives and other employees who may need access to claims.

The Results

The solution has allowed the company to reduce its medical claims processing time significantly, while increasing accuracy and eliminating manual data entry. Users are empowered with information at their fingertips and are equipped with the tools needed to provide more efficient customer service. As a result of the implementation, staff has been reallocated to conduct more valuable and productive tasks.

The system has met the company’s requirement for low maintenance. The Applications Manager, in charge of ensuring a smooth, efficient claims process, attests that the system just motors along reliably. “We like the thin client verify solution, because there’s really no maintenance required on the clients,” the LAN Administrator says.

Products and services used

IBM products and services that were used in this case study.

Software:
Datacap Taskmaster Medical Claims Capture

Footnotes and legal information

About IBM Enterprise Content Management IBM Enterprise Content Management software enables the world’s top companies to make better decisions, faster. By gaining control of unstructured information, companies can access, collaborate and influence business decisions in new ways, making content a first-class source of insight. With industry-specific IBM ECM solutions, companies can capture, manage and share content throughout its lifecycle to help ensure compliance, reduce costs and maximize productivity. The IBM ECM portfolio includes a wide array of capabilities that integrate with existing systems to help organizations maximize the value of information including: document capture and imaging; social content management; advanced case management; information lifecycle governance and content analytics. More than 13,000 global companies, organizations and government organizations rely on IBM ECM to improve performance and remain competitive through innovation. www.ibm.com/software/data/content-management.

© Copyright IBM Corporation 2011 IBM Corporation Software Group Route 100 Somers, NY 10589U.S.A. Produced in the United States of America May 2011 All Rights Reserved IBM, the IBM logo, ibm.com and FileNet are trademarks or registered trademarksof International Business Machines Corporation in the United States, other countries, or both. If these and other IBM trademarked terms are marked on their first occurrence in this information with a trademark symbol (® or ™), these symbols indicate U.S. registered or common law trademarks owned by IBM at the time this information was published. Such trademarks may also be registered or common law trademarks in other countries. A current list of IBM trademarks is available on the Web at “Copyright and trademark information” at: ibm.com/legal/copytrade.shtml Other product, company or service names may be trademarks or service marks of others. References in this publication to IBM products or services do not imply that IBM intends to make them available in all countries in which IBM operates.

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