Capital Blue Cross, a non-profit health insurer for Pennsylvania, is one of the largest area employers, with more than 2,000 employees serving Central Pennsylvania and the Lehigh Valley. Capital has now fully automated and streamlined its entire medical claims processing system across all of its offices, due to the deployment of Datacap Taskmaster for Medical Claims integrated with eiStream's (now Global 360) Imaging and Workflow for NT solution.
Capital's claims staff and IT department, processed handle a vast amount of data manually. Significant time was wasted organizing files and fixing the numerous mistakes that are inevitable when paper is the primary information source. The need for collaboration among the Company's three Pennsylvania offices aggravated a complexity that made providing efficient customer service a challenge.
Once Capital management decided to make the transition to digitization, they considered several vendors. After a rigorous investigation, Capital selected the Datacap Taskmaster for Medical Claims scanning solution linked to Kodak scanners and eiStream's image management solution to streamline the flow of information, eliminate unnecessary paperwork and improve customer service.
Claims are now batched right out of the mailroom and fed into the scanners. Taskmaster for Medical Claims applies Optical Character Recognition (OCR) technology to extract the required data from the claims. Database lookups help validate the data to make sure, for example, that the member number corresponds with the name, the CPT codes with the diagnosis, and the zip code with the city.
Once the medical claims have been electronically "scrubbed," they are shown to a verify operator. If any field fails validation, it's highlighted in red, making it easy for operators to correct with a keystroke. Finally, claim data is sent to an adjudication system and images and data are uploaded to the eiStream system for efficient storage and retrieval by customer.
The solution has allowed Capital Blue Cross to reduce its medical claims processing time significantly, while increasing accuracy. Users are empowered with information at their fingertips and are well equipped with the tools to provide more efficient customer service. As a result of the implementation, Capital staff has been reallocated to conduct more valuable and productive tasks.
Today, Capital is extending its customer service benefits to include easy access to all information via the Web. "Like most companies we are 'web enabling' applications that make sense to improve our customer relationships," said Brad Wagner at Capital Blue Cross.