Medicare Supplemental Claims Processing Automation

Most medical insurers and clearinghouses receive at least the occasional CMS-1500. In CMS-related niche markets like Medicare supplemental (“MedSup”/”Medigap”) coverage, there is often a steady stream of paper claims forms.

For many Medigap insurers, CMS-1500 forms are so prevalent that a minor change in processing efficiency has a material impact on near-term reimbursement and cash flow.

Optimizing Data Entry for Medigap Claims

Initial data entry constitutes most of the time and cost of handling a CMS-1500 form, whether it is physical or scanned. After all, even the best human staff make mistakes and are strictly linear in scale.

This makes data entry the natural starting point when a MedSup insurer needs to reduce operating costs.

Optical character recognition (“OCR”) technology automates data capture to eliminate human input from the CMS-1500 workflow. This lets ClaimsCapture set automation benchmarks of 98-100% from scanned forms and 97% from faxes—a notoriously low-resolution format.

Benefits are immediate and easy to measure in terms of processing time, operating costs, error rates, and more.

However, data capture entry is just one piece of the puzzle, not the end-all, be-all of MedSup claims automation.

Intelligent CMS-1500 Data Capture

Validation is critical regardless of who or what extracted the data from a CMS-1500 form. Information that was correctly captured but incorrectly entered by the provider/billing service may lead to costly denials or underpayments.

For instance, is the patient a member of that MedSup plan? Are the biographical data plausible (and properly formatted)? Going a level deeper, was this claim previously submitted? Do any line items appear in another claim?

This depth of analysis is painstaking for human staff, and highly error-prone. And that’s why it is built into ClaimsCapture.

Before creating the final EDI 837 output, ClaimsCapture runs all data through sophisticated checks at the form, line-item, and field levels. These automatically detect the issues that we have most often seen in decades of work with claims processors. Furthermore, all business logic is customizable for unique data and workflow requirements.

Claims Automation: Fast, Proven ROI

The bottom line is that strategic ClaimsCapture implementations lead to order-of-magnitude reductions in processing time, immediate data quality improvement, and a positive ROI just months after going live.

To learn more about efficiently handling the CMS-1500, UB-04, and other essential forms in MedSup plan administration, please contact us today.