VAR’s Health Claims Workflow Solution Wins Healthcare Clients
“We re-engineer workflows to leverage technology” declares Michael Wilson, president and CEO of VAR HealthCare Information Management, Inc. (HCIM). HCIM accomplished this for John Muir/Mt. Diablo Health Network, a medical foundation serving the San Francisco Bay area.
Health Network previously outsourced data entry of HCFA (Health Care Financing Administration) 1500 claims forms with lackluster results. The monthly data file often failed to load, or provider and member eligibility information were mismatched, forcing Health Network to manually key data. According to Janiece Nolan, Health Network president/CEO, “This affected 30% of our HCFA claims.”
Experience, Previous Workflow Success Earn Install
HCIM presented Health Network with a solution previously developed for another healthcare provider with the same claims platform and similar workflows. “As a result of our new OCR [optical character recognition] solution with Claims Manager, Health Network moved five employees from data entry roles into other positions, saving the client more than $500,000 in operating expenses,” says Gregory Merica, ScanClaims product director at HCIM. HCIM and Health Network redesigned workflows based on the VAR’s ScanClaims solutions package, using forms processing and document image storage and retrieval. The solution includes: a Kodak 2500 scanner; AnyDoc Software’s OCR for AnyDoc for data capture and validation; AnyDoc® EXCHANGEit for data transfer into Claims Manager; AnyDoc® BROKERit with a SQL server for image storage and retrieval; Claims Manager, HCIM’s proprietary ScanClaims software that automatically researches claims eligibility and providers; and SymKey, HCIM’s automated claims examiner product.
Claims Manager prevents claims errors from entering the client’s adjudication system. First, it matches the member’s ID, name, and birth date against the client’s claims processing system. Then, it performs similar matching logic on healthcare providers. It also flags claims for manual review based on client-specific preprocessing rules. Health Network now uses the solution for authorization forms, allowing nonclinical staff to assist with tasks only RNs used to perform.
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Tags: Case Studies, ScanClaims