Case: Healthcare

Developing data entry solutions for a healthcare service provider

Case Summary

A leading service provider in the healthcare sector in the US wanted to enhance the efficiency of their operations for processing medical reimbursement claims.

The Client

The company is a key player in the medical healthcare industry.

Client Description

In the US, expenses incurred for services provided by physicians to patients can be reimbursed from insurance companies. The client helps its customers in processing their medical reimbursement claims. Documents that are processed herein include patient information on a standard form (including HCFA1500 and UB92), descriptions of procedures and services the physician provides, and dental forms.

The Challenge

The ChallengeProcessing a reimbursement claim can be a fairly time-consuming affair. A bill-to-receive-payment cycle normally takes 45 days, and that too, only if claims are filed accurately within a 24 to 48 hour period. Doctors who incorrectly bill their services may be fined up to $10,000. Hence, accuracy and fast turnaround time is of vital importance. Research findings indicate that the American healthcare agencies process around 3 billion medical claims per year.

The Solution

• Scanned images are received from providers of health services as the input. Our FTP server receives these images in a secure form using PGP encryption.
• Our team of data entry operators key in the data and forms a database using proprietary "Key-From-Image" software. The workload was mandated to be "Double-Key-Verify" to obtain an accuracy level of up to 99.995 per cent.
• After completing the quality check, the output database is maintained in a client-defined format. The specifications were for ASCII, comma separated, EDI.
• This process is repeated on a daily basis more than 10,000 health claims are processed per day. In order to ensure SLA on accuracy, complex validation features are used for the execution of the task. SLA is maintained on the turnaround time by assigning a team of trained and productive data entry staff.
• Our expertise and strong in-house knowledge repository is optimally utilized to train all new recruits. This ensures that the new staff easily assimilates the workflow processes and becomes productive at a faster rate.

The Benefits

• Ability to handle daily fluctuations in the volumes of the medical claims
• Outsourcing an extremely labor-intensive process enables firms to focus on core revenue-generating processes
• HIPAA compliance
• Accuracy levels of 99.995 per cent - much higher than that for automated OCR/ICR software

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