ClaimsCapture Use Cases: Data Entry Automation in Real Life

ClaimsCapture fully automates data extraction and EDI 837 creation from CMS and ADA forms.

Of all the paper- and scan-centric workflows it can streamline, a handful are overwhelmingly common. Below, we’ll look at three representative examples.

Scenario 1: Replacing Manual Data Entry

Background

Firms often find that manual data entry, which sufficed in previous years, can longer support their growth. Eventually, the marginal capacity of more data entry staff is no longer worth the cost of hiring them. This typically prompts stakeholders to seek digital alternatives to their inherently limited manual processes.

For perspective, consider the manual work to get every desired character from a CMS-1500 form as pictured below.

OCR-based automation is effectively a “fast-forward” button that delivers standalone data quickly, accurately, and without the headaches. For example, just a few seconds of processing transforms the input above into the following output.

Impact & Metrics

Concerns with claims per day usually drive the migration to an OCR platform, so it remains the most visible and critical metric. It also improves immediately upon go-live. For instance, in a recent project with a public health agency, the number rose from just a couple dozen to four hundred per day.

Productivity skyrockets while manual input goes away, so cost per claim also falls dramatically. Order-of-magnitude improvements are common when ClaimsCapture directly replaces a manual workflow.

Opportunities & Challenges

Generally, organizations starting from a strictly manual baseline are smaller and have fewer form variations and third-party integrations than their enterprise counterparts. This streamlines implementation and balances out the more extensive process re-engineering required to migrate from fully manual to fully automated processing.

 

Scenario 2: Creating a New Process or Service

Background

Entering the insurance industry, opening a new line of business, or taking on new clients can spur organizations to introduce claims processing from scratch. Stakes and visibility are high in these cases, since the solution launch often coincides with—or in fact is—the business launch.

Impact & Metrics

As above, cost per claim is critical. It drives the pricing, staffing, and other cost structures that make the new service or business model viable. From day one, various measures of accuracy (such as percent of documents requiring manual intervention) will also be key predictors of client satisfaction.

Opportunities & Challenges

One of our recent deployments from scratch enabled the customer to serve a new client in the healthcare space. Even without prior experience in claims processing, the customer met time and accuracy SLAs quickly and consistently with ClaimsCapture.

When customers engage ClaimsCapture consultants well before launch, it is possible to create processes than yield 100% automation of CMS and ADA forms. High rates are possible in virtually all cases, but early workflow engineering with automation experts is the surest path to reliably hands-off processing. Naturally, this reduces cost per claim by avoiding manual intervention (and related staffing) in the first place.

 

Scenario 3: Replacing Outsourced Processing

Background

When claims volume is no longer manageable in-house, outsourcing is a compelling option. Many customers explore it, only to find legal concerns and infrastructure headaches as data enters and leaves their network. Issues of outsourcing provider quality, cost, and reliability are also common. ClaimsCapture is a radically different approach that removes claims volume constraints without passing a single byte to third parties.

It also validates data with nuance and precision that human workers cannot consistently match. For instance, rules as subtle as field-specific capitalization (among nearly infinite others) can elevate your data quality from adequate to exceptional.

 

Impact & Metrics

Claims per day is typically the standard by which users compare ClaimsCapture to manual service providers. Today’s outsourced claims velocity is a natural benchmark for tomorrow’s automated solution.

Accuracy is a common problem for outsourced services, in both data extraction and data validation. Closely tracking its consequences (like underpayment, denial, and PDR rates) will help measure ClaimsCapture’s progress against these previous pain points.

Opportunities & Challenges

Most firms that use outsourced, manual processing receive an enormous volume of claims forms. A difficult migration would have vast and expensive business impact. Project sponsors must prioritize a seamless migration that immediately meets or exceeds prior processing rates. When accuracy and continuity are everything, ClaimsCapture is proven platform at the enterprise scale.

 

Automation & Accuracy, Today

Time and again, ClaimsCapture has brought efficiency and high ROI to situations ranging from the common ones above to highly unique, one-off scenarios. With a balance of comprehensive out-of-the-box features and broad customization possibilities, your organization will gain a tailored toolkit for automated claims processing that simply works.

Please contact us today to learn more or to schedule a workflow analysis for your highest-impact processes.