Nine Ways to Tackle HCFA Claims

By Doug Henschen

ClaimPack — Captiva

ClaimPack is a scalable Windows 9X/NT medical claim module for the FormWare forms processing and document capture product line from Captiva (www.whebsys.com). This module automatically reads, analyzes, corrects and validates HCFA 1500 and UB92 forms and exports the information into workflow, document and database management systems. ClaimPack’s speed and accuracy are said to significantly reduce data-entry time and improve access to customer-service information.

ClaimPack excels at form identification, handling variations through dynamic form removal and detail-area processing. For example, ClaimPack can cope with faxed versions of dropout forms, and it is said to recognize and process more than 75 variants of the HCFA 1500 without presorting. It also handles multi-page forms and attachments. You write custom business rules in a fully integrated VBA environment. Many customers process as much as 85% of forms without manual intervention. For the remaining 15%, ClaimPack supports production-level key-from-image processing. Prices start at $30,000

ProductInfo 250

MediClaim — Cardiff

Low cost and speedy implementation are said to be the calling cards of Teleform MediClaim from Cardiff (www.cardiff.com). Introduced less than a year ago, MediClaim is described as a turnkey product for automating HCFA 1500 and UB-92 medical claim forms and attachments. Cardiff says the more than 35 MediClaim customers have shaved as much as 75% of the implementation time and 40% of the cost off of “the usual six-month, $100,000” claims processing projects. Users include third-party firms such as Associated Administrators, United Administrative Services and Wisconsin Office and Data Systems.

Relying on Windows 9X/NT and a “network cluster” load balancing system, MediClaim is said to save money on hardware, software, total cost of implementation and ownership. Organizations can cut claim processing time from 2-5 minutes down to 30 seconds. Throughput reportedly rises from 150 claims/person/day to more than 1,000 claims/person/day.

MediClaim can handle up to 200,000 claims per day. Prices start at $30,000 including custom dropout form templates for HCFA and UB-92 forms, the MediClaim Data Manager, the MediClaim Image Viewer and custom validations for CPT and ICD-9 codes.

ProductInfo 251

HealthAgent — CereSoft

HealthAgent is a HCFA 1500 and UB92 system capable of processing as many as 600 fully completed forms per hour. Developed by CereSoft (www.ceresoft.com), HealthAgent includes modules for form identification, workflow and automated recognition of any type of input, including machine print, hand print and cursive handwriting. Edit and correction modes support high-volume requirements with key-from-image entry and distributed off-site workstations. Data validation tables of any size can be added to enhance accuracy.

CereSoft’s FreeStyle recognition engine is unique in handling everything from machine print to unconstrained handwriting, both on the same form and on individual forms in any batch. ActiveX controls allow customization of any processing module and integration of HCFA processing into other claim adjudication systems. HealthAgent supports Windows 9X/NT, and prices starts at $15,000.

ProductInfo 252

ELA-NT 7.0 — ComCom Systems

ELA-NT from ComCom Systems (http://comcom.net) is 32-bit automated data-entry and production-level key-from-image software that can be applied to HCFA claims processing. It provides high-speed scanner control, image enhancement, form detection/removal and OCR/ ICR/OMR/barcode recognition, with everything controlled from the user interface without programming or scripting.

ELA-NT combines a graphical template design, unique validation designer and 32-bit batch workflow in an open system design for automated data-entry and document management. Modular architecture lets you scale processes from a few hundred forms per day to thousands of forms per hour. Everything from scanning, template design, recognition and validation through final output formatting and database population is configured using the user interface with no scripting required.

Single-station software starts at $15,000, while a mid-volume, distributed systems starts at $37,000.

ProductInfo 253

ClaimWorks — Recognition Research

ClaimWorks is the health insurance claims processing configuration of the FormWorks system from Recognition Research (www.rrinc.com). It employs advanced auto-adjudication techniques to provide an accurate, flexible, cost-effective solution that has been recognized among the leaders in HCFA 1500, UB-92 and Dental (ADA) form processing. Customers include Medicaid processing in California and Alabama, Delta Dental of Michigan, EDS, MetLife, a number of Blue Cross/Blue Shield locations and other indemnity insurers, HMOs, PPOs and TPAs.

ClaimWorks manages the claims process from workflow to integration with legacy systems. OCR and ICR recognition are tuned specifically for HCFA and UB processing. Auto capture, data validation and data correction modules were built on a thorough analysis of the entire claims process, increasing the amount of automatic recognition and correction and reducing manual data entry. RRI says customers have cut their data entry costs by a factor of five or more, with throughput reaching as high as 300 claims per hour per operator.

ClaimWorks operates on Windows 3.X/9X/NT and will scale to handle more than 250,000 claims per day. Pricing starts at $100,000.

ProductInfo 254

ImageEMC++ — Scan-Optics

ImageEMC++ from Scan-Optics (www.scanoptics.com) is specifically designed to minimize the labor-intensive cost of processing paper health claim forms. Using the power of Windows NT and an object-oriented database structure, the system combines scanning, advanced image processing, ICR, rules-based logic and process-engineered workstations to dramatically improve productivity. Claims can be fully automated with intelligent routing directing suspense claims to adjusters for data validation. The system handles from 500 to more than 250,000 claims per day. Turnkey system pricing starts at $100,000 including software, integration, workstations and scanners, but you can incorporate existing hardware.

ProductInfo 255

VDE+Images — Viking

The VDE+Images data-entry system from Viking Software (www.vikingsoft.com) is designed to increase the speed and accuracy of key-from-image and key-from-paper data entry. It offers the high-speed, high-production features that are essential for HCFA data-entry processing. Extensive field edits work dynamically. For example, if one field indicates that a person is single, all fields relating to spousal information will be skipped. EDS uses VDE+Images to process HCFA forms in six US locations.

VDE+Images can be integrated with best-of-breed imaging systems, and it supports data entry operators at speeds exceeding 20,000 keystrokes per hour. The Windows 9X/NT software costs $1,000 per seat with volume discounts available.

ProductInfo 256

Claims Factory — Gtess

If you’d rather outsource than implement technology in-house, the Claims Factory service from Gtess (www.gtess.com) presents a simple price-per-page processing solution. There are several different outsourcing options, including the flexibility to place scanners at the payor mail room for quick and easy access.

The Claims Factory relies on Gtess’ advanced imaging and recognition technology to convert paper claims into electronic data. Database management techniques support both industry- and provider-specific eligibility edits to ensure data accuracy and preparedness for the adjudication process. Claims data is formatted into output specifications that comply with NSF 2.0, ANSI 837 or proprietary mapping, ensuring that data is passed cleanly and accurately to the claims system.

ProductInfo 257

HCFA Forms Processing — Image Entry Inc.

Image Entry Inc. (www.imageentry.com) provides traditional data entry, heads-up data entry and online data entry for all types of medical claim forms. Based in Kentucky, Image Entry’s experienced workforce is said to offer a cost-effective solution without big-league, time-consuming investments in technology.

Pricing is based on volumes.

ProductInfo 258