The Problem

Precision Data Imaging, Inc. was chosen to implement a solution which would allow our client to reduce staff, decrease processing time, and allow greater and faster tracking of claims.  Our client was able to cut claims processing costs in half by allowing Precision Data Imaging to stamp, scan, process and turn their paper claims into an EDI claim.  All claims data entry is now outsourced which allowed the client to relieve all temporary staff, cut many regular staffers and reassign quality staffers to more business oriented processes.  The stamping department was eliminated which further increased savings.

The average claim was left in the filing cabinet after initial stamping for three to four weeks before any processing was attempted.  The client urgently needed a solution to increase production, decrease claims costs, and deliver better service to the claims submitters.

The Solution

Claims are picked-up daily from a PO box, which are stamped with a bar-coded micro image number before they are scanned. The numbers are then reported to the client within 24 hours. After all documents are scanned and processed the scanned numbers are compared to the stamped numbers to ensure no claims were missed.

Each claim is scanned at 300 dpi by our VRS scanners and then checked by our quality control operators. Image processing is used to check for skew, brightness/contrast, and alignment. All handwritten color images are scanned in color to obtain the highest image quality.  Any images that do not pass initial quality tests are rescanned.

Type written forms that are printed on Red-Line dropout forms are OCR’d (Optical Character Recognition) by two separate OCR engines to extract the needed data. The software then decides which data is more reliable by using advanced algorithms. All CPT, HCPCS, Insured IDs, Tax IDs and Place of Service are keyed a second time and then compared to the original OCR’d data.

Black and White and/or handwritten claims are manually keyed by our data processors.  All fields  follow custom business rules and are validated against customer supplied tables to ensure accuracy. All fields have rules built into the processing, for example, valid date ranges, data lengths, alpha, numeric, alpha-numeric data, and much more.

After all processing is completed and all files converted to the ANSI 837 file format, an email is sent confirming the files are available for immediate download or delivery. Every 24 hours, a days worth of claims are ready for delivery.

The Result

All paper claims now come back to the client in an ANSI X12 industry standard digital format along with a scanned image of the original claim.  This format mimics the format of electronic claims and virtually allows the client to have a paperless claims department.

Processing time was cut down from 30 days to 15. An image of the original claim is retained on the client's imaging system for instant retrieval.  No claims are ever lost due to misfiling which keeps claims submitters very happy.  Claims are always accounted for as they are stamped with a unique barcode. 

The client’s claims department went from utter chaos to a model of efficiency and accountability.  Before Precision Data Imaging's solution a backlog of claims of fifteen to thirty days was common place. Since we initiated our services that problem no longer exists today.