DCA News Blog
Streamline Medical Claims Processing with Capture Technology
Posted on 1/11/2011
The Healthcare Billing and Management Association reports that the frequency of overpayments, rejections, and denials on medical claims often reaches 50%, primarily due to manual data entry errors and the high complexity of claims. The main challenge of claims form processing is manual data entry, which creates a bottleneck at the front end of the process, delaying payments and increasing per-claim processing costs. This issue can be addressed by the introduction of a front-end capture system, which minimizes manual keying of data, resulting in improved productivity, data accuracy, customer service, and profits, all while cutting costs.
Due to the high volume of data fields found in medical claims forms, the per-claim processing cost can reach up to four dollars per claim with manual methods. With robust OCR technology, capture systems are able to achieve high automatic extraction rates to ensure that data is always found correctly on the form and verified for accuracy. Capturing information from CMS-1500 and UB-04 paper forms allows health insurers to accelerate the processing of claim forms and supporting documents, and the delivery of that information to business systems and content repositories.
Once information is extracted from a claim form, customized business rules are automatically applied to validate the information according to data format and field content requirements outlined by the American Medical Association (AMA). Information relating to medical treatments is also verified against AMA Current Procedural Terminology (CPT) code databases, and patient data is verified against the insurer’s existing customer database. Because the information contained in these database records may frequently change or need to be updated, it can be difficult for operators to know if they are using the most current information. An automated lookup ensures that data is current and accurate. Verified data is then delivered to a back-end content management system, and workflow can be applied for use in analysis, reporting, and retrieval.
Automated processing of CMS-1500 and UB-04 paper claim forms can significantly reduce operational costs and eliminate 80% of payment errors during data entry. For more information on how to lower labor expenses, improve data accuracy and increase turnaround times in claims processing, please call (908) 735-0393 or contact us online.
Tags:
healthcare
claims processing
document capture
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