What is Claims Processing Automation Software?
Claims Processing Automation Software is able to read the text from EOBs, CMS 1500 (formerly HCFA 1500) and soon CMS 1450 forms, and UB-04 (formerly UB-92) documents, then upload the information directly to your claims processing system. This greatly reduces the expensive data entry costs incurred by organizations that process these forms.
These systems use Optical Character Recognition (OCR) to recognize machine printed data from scanned images, as well as Intelligent Character Recognition (ICR) that can read hand printed data.
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Who can benefit from Claims Processing Automation?
Any organization that enters data from health care claim forms and EOBs can benefit greatly from automating the process with Forms Processing Software. If you have more than 1/3 of a full time employee's time dedicated to this task you can save money with a recognition solution.
Besides the savings in time and labor, recognition systems provide a superior data entry interface that helps reduce errors. They also decrease the overall time it takes to process claims, ensuring faster payments.
How much do Claims Processing Automation systems cost?
There are some solutions that are higly customized and integrated, but these are cost prohibitive for all but the largest companies. ScanStore has developed solutions for automating CMS 1500 and UB-04 forms using the affordable ABBYY FlexiCapture data capture solution that gives you the same data entry automation at a much lower cost.
The total cost of a Claims Processing Automation solution includes several items:
- Cost of the software
- Time to install and configure the software
- Integrate validation checks with claims software to ensure data like claimant, procedure code, diagnostic code, facility, etc. exist and are valid
- Integrate data export with claims software
- User and administrator training
- Labor required to verify recognition results
- IT infrastructure and maintenance costs
If you are processing Explanation of Benefits (EOB) files, there is additional configuration time required to adjust the baseline recognition template to read the specific formats of your commonly used insurance providers.
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If you have an IT staff that is familiar with document scanning and OCR applications, it is possible to do much of the configuration and maintenance in-house. If not then it is highly recommended that you use our Consulting Services to guide you through the setup process.
But you just want to know the price, right? The total cost for software, hardware, and consulting for a typical implementation starts at about $15,000. If that sounds like a lot of money then you either don't process a lot of claims forms or haven't calculated all the costs associated with manual data entry!
Contact Us to get a professional analysis of your project requirements and a full time and cost estimate.
What is the typical Claims Processing Automation workflow?
There are several steps involved in the process of scanning and recognizing claim forms data. Here is how it works in day to day operation:
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- Paper prepped for scanning (unfolded, staples removed, etc.)
- Forms are scanned on a high-speed document scanner
- Data on the scanned forms is recognized with Intelligent Character Recognition (ICR)
- Recognized data is assigned a 'confidence' value according to the recognition quality
- Data fields considered 'low confidence' are presented to users for manual review and correction
- Once all errors are corrected, data is exported directly to your claims processing database, or to an XML data file that can be imported automatically.
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The key thing is that the hardest part, typing in all the data from the forms, is now an automated step. This manual step is replaced by scanning and reviewing the recognized data. Roughly 5% of the data will be presented for review (up to 10% for hand-printed forms) and most of the reviewed data will not require corrections. This means the total time for the new workflow is less than half of the time it takes for manual data entry.
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